title: Multiple systemic embolism in infective endocarditis underlying in Barlow's disease.
abstract: BACKGROUND
  Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE. Unfortunately, clinical trial results have been inconclusive.
  
  
  METHODS
  We describe a previously healthy 50-year-old man who presented with dysarthria secondary to bacterial endocarditis with multiple cerebral, coronary, splenic, and peripheral emboli; antibiotic therapy contributed to the multiple emboli. Emergency splenectomy was performed, with subsequent mitral valve repair. Pathological examination confirmed mucoid degeneration and mitral valve prolapse (Barlow's disease) as the underlying etiology of the endocardial lesion. Continuous antibiotics were prescribed, postoperatively. Transthoracic echocardiography at 1.5, 3, and 6 months after the onset of his illness showed no severe regurgitation, and there was no respiratory distress, fever, or lethargy during follow-up.
  
  
  CONCLUSIONS
  Although antibiotic use in IE carries a risk of septic embolism, these drugs have bactericidal and antithrombotic benefits. It is important to consider that negative blood culture and symptom resolution do not confirm complete elimination of bacteria. However, vegetation size and Staphylococcus aureus infection accurately predict embolization. It is also important to consider that bacteria can be segregated from the microbicide when embedded in platelets and fibrin. Therefore, antimicrobial therapy with concurrent antiplatelet therapy should be considered carefully.
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.|Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China.
authors: Ziqing
authors: Z
authors: Yu
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors: Bing
authors: B
authors: Fan
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors: Hongyi
authors: H
authors: Wu
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors: Xiangfei
authors: X
authors: Wang
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors: Chenguang
authors: C
authors: Li
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
authors: Rende
authors: R
authors: Xu
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. su.yangang@zs-hospital.sh.cn.
authors: Yangang
authors: Y
authors: Su
authors: Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China. ge.junbo@outlook.com.
authors: Junbo
authors: J
authors: Ge
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004452:Echocardiography; D004562:Electrocardiography; D004617:Embolism / Q000175:diagnosis* / Q000209:etiology; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006321:Heart / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000150:complications* / Q000175:diagnosis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology; D013291:Streptococcus / Q000302:isolation & purification; D013616:Tachycardia, Sinus / Q000000981:diagnostic imaging; D020107:Troponin T / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D020107:Troponin T
keywords: Antiplatelet treatment; Embolism; Infective endocarditis