Open AccessBrachial Mycotic Pseudoaneurysms Due to Prosthetic Valve Infective Endocarditis: A Case Report and Review of the Literature
Author(s) -
Ovidiu Știru,
Roxana Carmen Geana,
Liana Văleanu,
Adrian Tulin,
Laura Răducu,
Vlad Anton Iliescu
Publication year - 2020
Publication title -
the heart surgery forum/the heart surgery forum
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.255
H-Index - 38
eISSN - 1522-6662
pISSN - 1098-3511
DOI - 10.1532/hsf.2951
Subject(s) - medicine , pseudoaneurysm , surgery , endocarditis , mitral valve replacement , complication , radiology , heart failure , infective endocarditis , brachial artery , pulsatile flow , intracardiac injection , physical examination , mitral valve , cardiology , blood pressure
Brachial mycotic pseudoaneurysms (BMPA) are a rare complication of infective endocarditis (IE), but potentially could be a limb-threatening condition. We present the case of a 38-year-old male referred to our department, complaining of the sudden onset of a painful pulsatile mass 5 x 10 cm in the right antecubital fossa that slowly progressed over time. Two years before this, he underwent aortic and mitral valve replacement with mechanical prosthetic valves and tricuspid annuloplasty for IE with methicillin-susceptible Staphylococcus aureus after a six-week course of intravenous antibiotherapy with oxacillin. Clinical examination of the right upper limb revealed a pulsatile and compressible mass with a normal temperature and without other clinical signs of inflammation. Pulse of the axillary artery, brachial and radial arteries were palpable. He was diagnosed by Doppler ultrasonography and digital subtraction angiography with BMPA.Furthermore, transesophageal echocardiography (TEE) revealed normal function of the aortic and mitral prosthetic valve with no signs of prosthetic valve endocarditis and no feature of congestive heart failure. Considering these clinical findings, surgical treatment was planned. He underwent re-section of the brachial pseudoaneurysm and arterial reconstruction. One year after the pseudoaneurysm resection, evolution was excellent. This manuscript presents this rare, uncommon complication after IE and also reviews the available surgical management strategies for this pathology.