Gastric Adenocarcinoma Associated with Acute Endocarditis of the Aortic Valve and Coronary Artery Disease in a 61-Year-Old Male with Multiple Comorbidities—Combined Surgical Management—Case Report

Abstract

The case of a 61-year-old male with a recent total gastrectomy for a hemorrhagic gastric tumor is presented, with the important co-morbidities of type II diabetes mellitus requiring insulin, chronic hepatitis C with liver dysfunction, stage II essential hypertension, chronic stage III renal disease peripheral type II aorto-iliac disease with stage II ischemia of both legs, and chronic anemia. About one month following the gastrectomy, the patient presented with fever and acute inflammatory syndrome. Severe aortic insufficiency, aortic valvular vegetations, and positive blood cultures with Staphylococcus saprophytic were found. The diagnosis of infectious endocarditis on the aortic valve was established (positive blood cultures with echocardiographic features of vegetations, fever), and antibiotic treatment with Levofloxacin and Vancomycin was initiated. The evolution was favorable with the remission of the inflammatory syndrome and quick cessation of fever. However, the hemodynamic aspect showed progressive heart failure with acute pulmonary edema. The transesophageal echocardiographic examination confirmed the existence of severe aortic insufficiency and valvular vegetations with a left ventricular ejection fraction of 38%. The coronary angiography revealed double vessel disease. The calculated Euroscore II was 33.4%. Aortic valve replacement with porcine xenograft and double coronary artery bypass graft surgery was performed. The patient had a favorable postoperative course remaining afebrile and out of heart failure, with the markers of inflammation largely within normal limits. The left ventricular ejection fraction increased to 50%. The successful outcome of this case, represented by a rare association of cancer, endocarditis, and coronary disease, reveals the importance of the multidisciplinary teams involved in this case: gastroenterology, general surgery, cardiology, infectious diseases, cardiac surgery, and intensive care. Therefore, in such cases with high risk, complex patients, a strong collaboration between all specialties is needed to overcome all of the limitations of the patient’s co-morbidities.

Surgical Treatment in a High-Risk Pulmonary Embolism: Case Report

“…Precise recognition of possible complications is important for the medical and surgical management of these patients, as those complications could generate unexplained congestive heart failure and hemodynamic deterioration [ 11 ]. The importance of involving multidisciplinary teams (including specialists in cardiology, cardiac surgery, and intensive care) in complex cases with high risks is revealed by the successful outcome [ 12 , 13 , 14 , 15 , 16 ]. After the diagnosis of a massive pulmonary embolism is made, there must be immediate initiation of medical or surgical treatment.…”

Frenemies within: An Endocarditis Case in Behçet’s Disease

“…This type of endocarditis in BD involves mainly the right heart valves, and right heart thrombi should generally raise the suspicion of BD [ 8 , 9 ]. The differential diagnosis in this setting includes myxoma, fibroelastoma or malignant tumors [ 11 , 12 ]. Other causes of tricuspid or pulmonary endocarditis, such as intravenous drug use, interatrial or interventricular communications, intracardiac devices or central venous catheters, were not present in our patient [ 4 ].…”

Open Coronary Endarterectomy of Left Anterior Descending Artery—Case Report and Review of Literature

“…Coronary endarterectomy (CE) was initially described in 1957 by Bailey as a technique to achieve complete myocardial revascularization in patients with diffusely diseased coronary arteries [ 1 ]. Studies regarding the safety and necessity of this procedure are controversial and a standard technique of CE on the LAD has not yet been established [ 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. There is an increased risk of postoperative myocardial infarction when CE is performed on the LAD with potential fatal consequences [ 7 ].…”