Epidemiological Profile of Patients with Infective Endocarditis at three Tertiary Centers in Brazil from 2003 to 2017

Abstract Background Infective endocarditis (IE) is a disease with high morbimortality and an increasing incidence. With improved diagnosis and treatment, a number of epidemiological changes have been reported over time. Objectives We sought to describe the epidemiological profile, mortality predictors, and analysis of a possible microbiological transition in patients admitted to three tertiary centers in Brazil. Methods In this cross-sectional retrospective study, data from 211 patients with definite or probable IE were analyzed according to the modified Duke criteria between 2003 and 2017. The association between categorical variables was assessed using the chi-square or Fisher's exact test, and binary logistic models were built to investigate mortality. We considered p <0.05 statistically significant. Results The median age of the sample was 48 (33-59) years old, 70.6% were men, and the most prevalent pathogen was Staphylococcus spp. (19%). Mortality was 22.3%, with increasing age being the leading risk factor for death (p = 0.028). Regarding the location of the disease, native valves were the most affected site, with the aortic valve being more affected in men than women (p = 0.017). The mean number of cases of Staphylococcus spp. (τ = 0.293, p = 0.148) and Streptococcus spp. (τ = -0.078, p = 0.727) has remained stable over the years. Conclusion No trend towards reduced or increased mortality was evident between 2003 and 2017. Although Staphylococcus spp. were the most prevalent pathogen, the expected epidemiological transition could not be observed.

The frequency of infective endocarditis in candida bloodstream infections: a retrospective study in a child hospital

Abstract Introduction: Fungal endocarditis is reported less frequently than bacterial endocarditis, with an incidence of 0-12% of the total pediatric infective endocarditis. Objective: In this study, the incidence of infective endocarditis in Candida bloodstream infections in a tertiary hospital during the periods of 2007 and 2016 was reviewed. Methods: Patients with positive blood or catheter cultures in terms of Candida spp. during the study period of January 2007 and January 2016 were analyzed in terms of Candida infective endocarditis. Infective endocarditis was defined according to the modified Duke criteria. The outcome, possible associated predisposing factors for Candida endocarditis were determined. Results: 221 patients and 256 attacks with positive blood or catheter cultures in terms of Candida were included in the study. The most common Candida species was Candida parapsilosis, isolated in 157 (61.3%) attacks, followed by Candida albicans in 70 (27.3%). Neurological diseases (23%), hemato-oncological diseases (12.1%), previously known heart diseases (8.2%), inborn errors of metabolism (9%) were common comorbidities. Twelve (5.4%) patients had a previous history of cardiac surgery. Among the 221 patients, Candida endocarditis was present in only two (0.9%) of them. Conclusion: Although Candida infective endocarditis is an uncommon but frequently fatal infection in pediatrics, echocardiography should be performed routinely for patients with positive blood or catheter cultures in terms of Candida. Prompt and effective antimicrobial therapy might prevent cardiac surgery in selected cases, however this could not be a general rule for all patients.

Endocarditis Infecciosa: caracterización clínica de la enfermedad: revisión de casos de los últimos 5 años / Infective endocarditis: clinical experience in the last five years

Antecedentes: La Endocarditis infecciosa es una enfermedad grave y su incidencia ha aumentado en el último tiempo. En Chile faltan estudios observaciona-les que representen adecuadamente nuestra realidad local y nacional. Objetivo: Describir las características clínicas, ecográficas y bacteriológicas de los pacientes con Endocarditis Infecciosa del Hospital Carlos Van Buren de Valparaíso, entre los años 2012 y 2016. Métodos: Se realizó un análisis descriptivo de 35 pacientes con diagnóstico de Endocarditis infecciosa, recolectándose variables clínicas, imagenológicas y de laboratorio. Para describir los resultados se utilizó frecuencias, medianas y figuras. Resultados: Se observó un aumento de casos de Endocarditis infecciosa en los últimos dos años. Del total de pacientes con Endocarditis infecciosa, 28 casos (80%) eran de válvula nativa, siendo el compromiso más frecuente el de válvula aórtica. Se observó un aumento de las comorbilidades no cardíacas y de los casos provocados por el grupo Staphylococcus. Los síntomas más comunes fueron compromiso del estado general y fiebre, y las complicaciones más frecuentes fueron insuficiencia renal aguda, insuficiencia cardíaca aguda y fenómenos embólicos. Un total de 14 pacientes fallecieron producto de la infección, las complicaciones y cirugía. Conclusiones: Se realiza una caracterización actualizada de la enfermedad. Se necesitan más estudios con un mayor número de paciente para un mejor entendimiento de nuestra realidad.

Background: Infective endocarditis is a severe illness the incidence of which has increased over time. There are relatively few observational studies that adequately represent the characteristics of the disease in Chile. Aim: To describe clinical, echographic and bacteriological characteristics of patients with infective endocarditis at Carlos van Buren Hospital in Valparaíso, between 2012 and 2016. Methods: A descriptive analysis of 35 patients diagnosed with infective endocarditis was performed. Cinical, imaging findings and laboratory variables were collected. Relative frequencies, medians and figures were used to describe the results. Results: We observed an increase in cases of infective endocarditis in the last two years. Of all patients diagnosed with infective endocarditis, 80% had native valve involvement, more frequently at the aortic valve. There was an increase in non-cardiac comorbidities and Staphylococcus was identified as the main etiology. Weakness and fever were the most common symptoms, whereas more common complications were acute kidney and heart failure and embolic phenomena. A total of 14 patients died of infection, complications or after surgery surgery. Conclusions: An updated characterization of Infective endocarditis at a Chilean hospital is presen-ted. However, more studies are needed with a larger number of patients for a better characterization of the disease in our country.

Healthcare-Associated Infective Endocarditis: a Case Series in a Referral Hospital from 2006 to 2011 / Endocardite Infecciosa Associada aos Cuidados de Saúde: Série de Casos em Hospital de Referência entre 2006 e 2011

Background: Healthcare-associated infective endocarditis (HCA-IE), a severe complication of medical care, shows a growing incidence in literature. Objective: To evaluate epidemiology, etiology, risk factors for acquisition, complications, surgical treatment, and outcome of HCA-IE. Methods: Observational prospective case series study (2006-2011) in a public hospital in Rio de Janeiro. Results: Fifty-three patients with HCA-IE from a total of 151 cases of infective endocarditis (IE) were included. There were 26 (49%) males (mean age of 47 ± 18.7 years), 27 (51%) females (mean age of 42 ± 20.1 years). IE was acute in 37 (70%) cases and subacute in 16 (30%) cases. The mitral valve was affected in 19 (36%) patients and the aortic valve in 12 (36%); prosthetic valves were affected in 23 (43%) patients and native valves in 30 (57%). Deep intravenous access was used in 43 (81%) cases. Negative blood cultures were observed in 11 (21%) patients, Enterococcus faecalis in 10 (19%), Staphylococcus aureus in 9 (17%), and Candida sp. in 7 (13%). Fever was present in 49 (92%) patients, splenomegaly in 12 (23%), new regurgitation murmur in 31 (58%), and elevated C-reactive protein in 44/53 (83%). Echocardiograms showed major criteria in 46 (87%) patients, and 34 (64%) patients were submitted to cardiac surgery. Overall mortality was 17/53 (32%). Conclusion: In Brazil HCA-IE affected young subjects. Patients with prosthetic and native valves were affected in a similar proportion, and non-cardiac surgery was an infrequent predisposing factor, whereas intravenous access was a common one. S. aureus was significantly frequent in native valve HCA-IE, and overall mortality was high. .

Fundamento: A endocardite infecciosa associada aos cuidados de saúde (EI-ACS) é uma complicação grave associada aos cuidados médico-hospitalares, com uma incidência crescente na população. Objetivo: Avaliar a EI-ACS com relação à sua epidemiologia, etiologia, fatores de risco de aquisição, complicações, tratamento cirúrgico e quadro clínico. Métodos: Este estudo de caráter observacional e prospectivo avaliou uma série de casos reportados entre 2006 e 2011 em um hospital público no Rio de Janeiro. Resultados: Cinquenta e três pacientes com EI-ACS de um total de 151 casos de endocardite infecciosa (EI) foram incluídos no estudo, dos quais 26 (49%) eram do sexo masculino (idade média de 47 ± 18,7 anos), e 27 (51%) eram sexo feminino (idade média de 42 ± 20,1 anos). Quadros clínicos agudos de EI ocorreram em 37 casos (70%) e quadros subagudos em 16 casos (30%). A válvula mitral foi afetada em 19 casos (36%), e a valva aórtica em 12 casos (36%). As válvulas cardíacas protéticas foram afetadas em 23 casos (43%), e as válvulas cardíacas nativas em 30 casos (57%). O acesso venoso profundo foi usado em 43 pacientes (81%). Hemoculturas negativas foram observadas em amostras de 11 pacientes (21%). Nas hemoculturas positivas, Enterococcus faecalis foi identificado em 10 casos (19%), Staphylococcus aureus em 9 casos (17%) e Candida sp. em 7 casos (13%). Febre ocorreu em 49 pacientes (92%), esplenomegalia em 12 pacientes (23%), novo sopro de regurgitação valvar em 31 pacientes (58%) e proteína C reativa elevada em 44 pacientes (83%). O ecocardiograma apresentou critérios principais em 46 casos (87%). Trinta e quatro pacientes (64%) foram submetidos à cirurgia cardíaca. A mortalidade ocorreu em 17 casos (32%). Conclusão: EI-ACS afeta ...

Endocardites comunitárias por Bartonella spp. e Coxiella burnetii: investigações etioepidemiológica e clínica em pacientes com endocardite com culturas negativas / Community-acquired endocarditis due to Bartonella spp. and Coxiella burnetii: etiologic, epidemiologic and clinical investigations in patients with culture-negative endocarditis

Endocardite infecciosa é uma doença associada à elevada morbidade e letalidade. O diagnóstico precoce e o reconhecimento de sua etiologia podem contribuir para o sucesso do tratamento antibiótico; entretanto, cerca de um quarto das endocardites permanece sem diagnóstico etiológico. Este estudo teve como objetivo principal identificar a frequência de endocardite por Bartonella spp. e Coxiella burnetii dentre as endocardites com culturas negativas comunitárias e avaliar os fatores preditores dessas infecções. Como objetivo secundário compararam-se as características clínicolaboratoriais e prognósticas entre as endocardites comunitárias com culturas negativas e positivas. Foram avaliados também os fatores associados à letalidade intra-hospitalar das endocardites com culturas negativas. Entre janeiro de 2004 e janeiro de 2009, foram investigados 369 episódios consecutivos de endocardite em pacientes atendidos no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor HC-FMUSP. Foram estudados os casos que ocorreram em adultos, classificados pelos critérios de Duke modificados como "endocardite definida" e de origem comunitária. Assim, foram incluídos 221 episódios de endocardite, 170 com culturas positivas e 51 com culturas negativas. Neste último grupo, foram feitas as pesquisas sorológicas (reação de imunofluorescência indireta) e histopatológica de Bartonella spp. e Coxiella burnetii. Consideraram-se positivos títulos de imunoglobulina G (IgG) >= 800 para Bartonella henselae e ou Bartonella quintana, e IgG antifase I para C. burnetii > 800. O estudo histopatológico das valvas cardíacas foi capaz de identificar morfologicamente a etiologia de 87% das endocardites com culturas negativas, enquanto que o método de Gram do tecido a fresco o fez em somente 10% dos casos. As endocardites com culturas negativas apresentaram maior frequência de dispneia à admissão (p=0,001), menor valor de proteína C reativa (p=0,009)...

Infective endocarditis is associated with high morbidity and lethality. Early diagnosis and recognition of the specific etiology can contribute to successful antibiotic treatment. However, approximately one-fourth of endocarditis cases remain without an etiologic diagnosis. This study aimed to identify the frequency of endocarditis caused by Bartonella spp. and Coxiella burnetii among cases of community-acquired culture-negative endocarditis and to also assess risk factors for such infections. As a secondary objective, the clinical, laboratory and prognostic features of community-acquired endocarditis were compared. Factors related to the in-hospital lethality of culture-negative endocarditis were also assessed. Between January 2004 and January 2009, 369 consecutive cases of endocarditis were investigated in patients attending the no Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor HC-FMUSP. Cases occurring in adults, those classified by the modified Duke criteria as "defined endocarditis" and community-acquired cases were studied. In total, 221 cases of endocarditis comprising 170 culture-positive and 51 culturenegative cases were included. For the culture-negative cases, serology (indirect immunofluorescence reaction) and histopathological analyses for Bartonella spp. and Coxiella burnetii were performed. Cases were considered positive for Bartonella henselae or Bartonella quintana with IgG titers >= 800 and for Coxiella burnetii with antiphase I IgG titers > 800. Histopathological studies of the cardiac valves were capable of morphologically identifying the etiology in 87% of the culture-negative endocarditis cases, whereas the Gram stain was only positive in 10% of cases using fresh tissue. Culture-negative endocarditis patients presented a greater frequency of dyspnea on admission (p=0.001), lower C-reactive protein levels (p=0.009), and a lower left ventricular...

Análise descritiva de série de casos de endocardite infecciosa em pacientes pediátricos: estudo prospectivo de pacientes internados no Instituto Nacional de Cardiologia, 2006-2011 / Descriptive analyses of series of cases of infective endocarditis in pediatric patients: a prospective study of patients admitted to Instituto Nacional de Cardiologia, 2006-2011

Fundamentos: A endocardite infecciosa (EI) é uma doença infrequente, porém grave na infância. Objetivos: Descrever os achados clínicos, laboratoriais, ecocardiográficos, as complicações, a realização de cirurgia cardíaca, a letalidade e os fatores de risco associados a EI em crianças. Métodos: Estudo prospectivo, observacional descritivo do tipo série de casos, com pacientes na faixa etária abaixo de 18 anos internados de janeiro de 2006 até dezembro de 2011, no Instituto Nacional de Cardiologia, RJ – Brasil. Resultados: Foram identificados 40 pacientes e 43 episódios de EI. Os pacientes estudados foram divididos em grupo A, menores de um ano de idade, e grupo B, com um ano ou mais de idade. Dentre os pacientes analisados, 15 faziam parte do grupo A (37,5 por cento) e 25 do grupo B (62,5 por cento). Trinta pacientes (75 por cento) eram portadores de cardiopatia congênita, enquanto dez (25 por cento) eram pacientes portadores de cardiopatia adquirida. Submetidos à análise estatística, 5/15 (33,33 por cento) casos do grupo A versus 26/28 (92,6 por cento) casos do grupo B apresentaram diagnóstico definitivo de EI (p=0,00007, IC=0-0,28 e OR=0,04) pelos critérios modificados de Duke. A letalidade foi de 8/15 (18,75 por cento) no grupo A contra 10/28 (35,7 por cento) no grupo B (p=0,02 IC=1,11-1,77 OR=1,4)...

Infective endocarditis (IE) is an un commom but severe disease in children. Objectives: To describe clinical, laboratory, and echocardiographic findings,complications, surgical intervention, mortality and risk factors associated with infective endocarditis in children. Methods: This is a prospective, observational,descriptive case series study of patients less than 18 years old, admitted from January 2006 to December 2011, to the Instituto Nacional de Cardiologia, RJ –Brazil. Results: There were 40 patients and 43 episodes of IE. Patients were dividedas group A, i.e. those less than 1 year of age, and group B from 1 year old. In the studied patients, 15 were included in group A (37.5 percent) and 25 in group B (62.5 percent).Thirty patients (75 percent) had congenital heart disease while ten (25 percent) had acquired heart disease. Statistical analysis showed that 5/15 (33.3 percent) of cases from group Aversus 26/28 (92.6 percent) from group B presented a definite diagnosis of IE by the modified Duke criteria (p=0.00007, IC=0-0.28 e OR=0.04). Mortality was 8/15(18.8 percent) in group A vs 10/28 (35.7 percent) in group B (p=0.02 IC=1.11-1,77 OR=1.4)...

Caractetísticas clínicas y epidemiológicas de la endocarditis infecciosa en el INSN, 2005-2011 / Clinical and epidemiological Caractetísticas infective endocarditis in INSN, 2005-2011

Objetivo: Evaluar las características clínicas, epidemiológicas y microbiológicas de los pacientes con endocarditis infecciosa. Diseño: Estudio retrospectivo descriptivo longitudinal. Lugar: Instituto Nacional del Niño. Pacientes: Pacientes con diagnóstico de endocarditis infecciosa: Se revisó las historias clínicas de los pacientes con diagnóstico de endocarditis infecciosa atendidos entre enero 2005 y octubre de 2011. Se evaluó los criterios clínicos, de laboratorio y ecocardiográficos (criterios de Duke) empleados en el diagnóstico. Resultados: Del total de pacientes (n=78), 34 de ellos (43.6 por ciento) presentan defecto del septum ventricular, como patología congénita de base, seguido por ductus arterioso persistente con 26 pacientes (33.3 por ciento) y Tetralogía de Fallot con 16 pacientes (20.5 por ciento). De los 78 pacientes evaluados, 40 (51.3 por ciento) presentaron insuficiencia cardiaca...

Objective: Evaluate clinic, epidemiologic and microbiologic, characteristics of patients with infectious endocarditis. Design: Retrospective longitudinal descriptive. Location: National Institute of Child. Patients: Patients with a diagnosis of infective endocarditis: We reviewed the medical records of patients diagnosed with infective endocarditis treated between January 2005 and October 2011. We evaluated the clinical, laboratory and echocardiography (Duke criteria) used in the diagnosis. Main outcome measures. Results: Of all patients (n = 78), 34 of them (43.6 per cent) hadventricular septal defect, and congenitalpathology base, followed by patent ductus arteriosus in 26 patients (33.3 per cent) and tetralogy of Fallot with 16 patients (20.5 per cent). Of the 78 patients evaluated, 40 (51.3 per cent) had heart failure...

Epidemiology of infective endocarditis in Chennai, South India.

Background: Infective endocarditis (IE) is an infection of the endocardial surface of the heart. Despite recent advances in diagnosis and treatment, mortality rates remain high. Data on the prevalence, epidemiology and etiology of IE from India are sparse. Aims and Objectives: The aim of this study was to evaluate the clinical, laboratory, microbiological, and echocardiographic characteristics of IE patients in Chennai, south India. Materials and Methods: Patients were classified based on modified Duke criteria. Details of the clinical profile of the patients and laboratory data were recorded. Blood cultures were performed to establish the etiology. Results: Ninety six percent of patients had native valve endocarditis. Mitral valve was the most commonly affected valve. Conclusion: Rheumatic heart disease was the most common predisposing factor and fever was the most common clinical feature. Viridans group streptococci accounted of the culture positive cases.

Endocarditis infecciosa: una revisión bibliográfica necesaria / Infectious endocarditis: a necessary literature survey

Se revisaron diversas fuentes bibliográficas sobre endocarditis infecciosa, especialmente las que trataban aspectos clinicoepidemiológicos, diagnósticos y terapéuticos, a fin de confeccionar un trabajo que constituya un material para el estudio y la actualización de este tema; no obstante, se consideró la necesidad de continuar dicha investigación sobre otras determinadas características de esta infección para ampliar los conocimientos al respecto.

Diverse literature sources on infectious endocarditis were reviewed, especially those that dealt with clinical epidemiological, diagnostic and therapeutic aspects, in order to make an investigation that constitutes a material for the study and the update of this topic; nevertheless, it was considered the necessity to continue this investigation on other certain characteristics of this infection to widen the knowledge in this respect.

Endocardite infectieuse en milieu cardiographique Dakarois : etude descriptive a propos de 39 cas

L'endocardite infectieuse est une complication frequente des cardiopathies rhumatismales. L'objectif de ce travail etait de faire une etude descriptive de l'endocardite infectieuse; en milieu hospitalier Dakarois.Il s'agit d'une etude retrospective; descriptive; realisee a la clinique cardiologique de l'hopital Aristide Le Dantec; durant la periode allant de Janvier 2004 a Decembre 2008. Etaient inclus tous les patients hospitalises et traites pour endocardite infectieuse certaine ou probable; selon les criteres de Durack. Nous avons etudie les parametres epidemiologiques; cliniques; biologiques et echocardiographiques.Le nombre total d'admissions dans le service durant la periode d'etude etait de 3746 patients; dont 870 pour valvulopathies rhumatismales. Nous avions enregistre 39 cas d'endocardite infectieuse soit une prevalence de 1;04et 4;48valvulopathies rhumatismales. L'age moyen de nos patients etait de 24 plus ou moins 11;5 ans avec des extremes de 6 et 52 ans. Plus de la moitie des patients soit 58;9(23 patients) avaient moins de 25 ans. On notait une legere predominance feminine avec un sex-ratio homes/femmes de 0;95. La porte d'entree etait essentiellement bucco-dentaire 40. L'anemie etait constante avec un taux d'hemoglobine moyen a 8;4g/dl. Les hemocultures etaient positives chez 6 patients et le Staphylococcus Aureus etait le germe le plus retrouve. L'electrocardiogramme avait montre des troubles du rythme et de la conduction respectivement dans 69;2 et 10;2des cas. L'echographie cardiaque mettait en evidence des vegetations chez tous les patients; une rupture de cordage dans 6 cas et un abces chez trois patients.L'endocardite infectieuse constitue encore une realite dans nos regions. Elle survient habituellement sur cardiopathie rhumatismale. Son diagnostic repose sur les hemocultures et l'echocardiographie

Endocardite relacionada aos marcapassos / Pacemakers-related endocarditis

JUSTIFICATIVA E OBJETIVOS: Nos últimos anos houve um aumento nas indicações de marcapassos e cardioversores-desfibriladores implantáveis; que terão como consequência um aumento da incidência de endocardite associada à dispositivos intravasculares, adquirindo especial relevância para o conhecimento dos clínicos enquanto entidade nosológica e incluindo-a em seus diagnósticos diferenciais. O objetivo deste estudo foi descrever a epidemiologia, características clínicas, diagnóstico, tratamento e prognóstico da endocardite associada aos marcapassos. CONTEÚDO: A endocardite deve ser suspeitada nos portadores de marcapassos que apresentem febre de origem desconhecida, bronquite ou pneumonia recorrente e/ou sintomas locais no local de implantação. Os estafilococos coagulase negativo são em muitos casos os germes responsáveis, tendo muito cuidado ao classificar uma hemocultura positiva como uma contaminação, determinando a importância do S. schleiferi na infecção dos dispositivos intravasculares. Ecocardiograma transesofágico(ETE) é o exame de imagem de eleição, porém quando negativo não exclui a doença. Os critérios Médica de Duke apresentam baixa sensibilidade na endocardite relacionada ao marcapasso, sendo necessário estabelecer critérios diagnósticos específicos. O tratamento de escolha é a retirada do marcapasso e antibioticoterapia parenteral, com atividade antiestafilocócica, durante 4-6 semanas. A retirada percutânea apresenta menor morbimortalidade em comparação com a cirurgia e pode ser realizada, de forma relativamente segura, em vegetações maiores de 10 mm. CONCLUSÃO: A endocardite relacionada aos marcapassos é uma entidade nosológica importante e deve ser incluída nos diagnósticos diferenciais de pacientes portadores destes dispositivos com quadros infecciosos.

Evolução pós-operatória de pacientes com refluxo protético valvar / Evolución postoperatoria de pacientes con reflujo protésico valvular / Postoperative outcome of patients with prosthetic valve leak

FUNDAMENTO: O refluxo de prótese valvar é uma possível complicação da cirurgia de troca valvar. Embora raro, suas consequências podem ser graves. Há poucos estudos que correlacionam o grau do refluxo de prótese valvar com os eventos clínicos dos pacientes. OBJETIVO: Comparar a evolução pós-operatória de pacientes com refluxo de prótese valvar discreto/moderado (D/M) ou importante (Imp). MÉTODOS: Dentre 1.350 pacientes submetidos a cirurgia valvar entre 1999 e 2001, foram selecionados 185 pacientes com refluxo de prótese valvar. Desses pacientes, foram avaliados retrospectivamente dados clínicos, laboratoriais e ecocardiográficos de uma amostra de 58 pacientes (37 homens) com refluxo de prótese valvar no pré e/ou no pós-operatório de troca valvar com dados completos em prontuários, sendo 36 com refluxo D/M versus 22 com refluxo Imp. RESULTADOS: A incidência de reoperação foi de 11,1 por cento no Grupo D/M versus 22,7 por cento no Grupo Imp (odds ratio = 2,35 [IC95 por cento 0,56-9,94]). Endocardite foi a causa de reoperação em 75 por cento dos pacientes do Grupo D/M e em 60 por cento do Grupo Imp. As biopróteses aórticas foram as mais acometidas por refluxo (55,8 por cento no Grupo D/M e 57,7 por cento no Grupo Imp). Evoluíram sem refluxo de prótese valvar no segundo pós-operatório 40 por cento dos pacientes com refluxo prévio D/M versus 21,4 por cento dos pacientes com refluxo de prótese valvar Imp. Não houve diferenças significantes nas variáveis laboratoriais. CONCLUSÕES: (1) Os portadores de refluxo importante têm maior probabilidade de reoperação. (2) Endocardite foi a causa mais frequente de reoperação para qualquer grau de refluxo. (3) O refluxo de prótese valvar importante é de mais difícil resolução completa após tratamento cirúrgico.

BACKGROUND: Prosthetic valve leak is a possible complication of surgical valve replacement. Although uncommon, its consequences may be serious. Few studies correlate the degree of prosthetic valve leak with clinical events. OBJECTIVE: To compare the postoperative outcome of patients with mild/moderate (Mi/Mo) or severe (Sev) prosthetic valve leak METHODS: A total of 185 patients with prosthetic valve leak were selected among 1350 patients undergoing heart valve surgery between 1999 and 2001. Of these, a sample of 58 patients (37 men) with prosthetic valve leak (36 with Mi/Mo versus 22 with Sev leak) in the pre and/or postoperative period of heart valve replacement had complete medical record data, so their clinical, laboratory and echocardiographic data could be retrospectively assessed. RESULTS: The incidence of reoperation was 11.1 percent in the Mi/Mo group, versus 22.7 percent in the Sev group (odds ratio = 2.35 [95 percent CI 0.56-9.94]). Endocarditis was the cause of reoperation in 75 percent of the patients of the Mi/Mo group and in 60 percent of the Sev group. Aortic bioprostheses were those most frequently related to leak (55.8 percent in the Mi/Mo group and 57.7 percent in the Sev group). Forty percent of the patients with previous Mi/Mo leak did not present prosthetic valve leak on postoperative day 2 versus 21.4 percent of the patients with Sev prosthetic valve leak. No significant differences were found regarding laboratory variables. CONCLUSIONS: (1) Patients with severe leak are more likely to undergo reoperation. (2) Endocarditis was the most frequent cause of reoperation for any leak degree. (3) Severe prosthetic valve leak is more difficult to fully resolve after surgical treatment.

FUNDAMENTO: El reflujo de prótesis valvular es una posible complicación de la cirugía de reemplazo valvular. Aunque raras, sus consecuencias pueden resultar severas. Hay pocos estudios que correlacionan el grado del reflujo de prótesis valvular con los eventos clínicos de los pacientes. OBJETIVO: Comparar la evolución postoperatoria de pacientes con reflujo de prótesis valvular leve/moderado (L/M) o severo (S). MÉTODOS: Teniendo en cuenta a los 1.350 pacientes sometidos a la cirugía valvular entre el 1999 y el 2001, se seleccionaron a 185 pacientes con reflujo de prótesis valvular. De ellos, se evaluaron retrospectivamente datos clínicos, laboratoriales y ecocardiográficos de una muestra de 58 pacientes (37 varones) con reflujo de prótesis valvular en el pre y/o en el postoperatorio de reemplazo valvular con datos completos en prontuarios, con 36 presentado reflujo L/M versus 22 con reflujo S. RESULTADOS: La incidencia de reoperación fue del 11,1 por ciento en el Grupo L/M versus el 22,7 por ciento en el Grupo S (odds ratio = 2,35 [IC95 por ciento 0,56-9,94]). La Endocarditis fue la causa de reoperación en el 75 por ciento de los pacientes del Grupo L/M y en el 60 por ciento del Grupo S. Las bioprótesis aórticas fueron las más afectadas por reflujo (el 55,8 por ciento en el Grupo L/M y el 57,7 por ciento en el Grupo S). Evolucionaron sin reflujo de prótesis valvular en el segundo postoperatorio el 40 por ciento de los pacientes con reflujo previo L/M versus el 21,4 por ciento de los pacientes con reflujo de prótesis valvular S. No hubo diferencia significantes en las variables laboratoriales. CONCLUSIÓN: 1) Los portadores de reflujo severo tienen mayor probabilidad de reoperación. 2) Endocarditis fue la causa más frecuente de reoperación para cualquier grado de reflujo. 3) El reflujo de prótesis valvular severo es de más difícil resolución completa tras tratamiento quirúrgico.

Endocarditis infecciosa: análisis retrospectivo en el Hospital Nacional Arzobispo Loayza, 2002-2007 / Infective endocarditis: retrospective analysis at the Hospital Nacional Arzobispo Loayza between 2002 and 2007

Objetivo: Describir las características clínicas, epidemiológicas y microbiológicas de pacientes con endocarditis infecciosa (EI). Material y métodos: Estudio retrospectivo y analítico. Se revisó historias clínicas de pacientes con diagnóstico probable o definitivo de EI según criterios de Duke modificados hospitalizados en el Hospital Nacional A. Loayza entre enero del 2003 y diciembre del 2007. Se determinó la frecuencia de EI y criterios diagnósticos, características clínicas, del ecocardiograma, microbiológicas, complicaciones, tratamiento y letalidad. Resultados: Se incluyeron 33 casos de EI, de los cuales 18 (54.5%) tuvieron diagnóstico definitivo. La incidencia calculada durante los cinco años fue de 0.91 casos por 1 000 hospitalizaciones. La media de edad fue de 40±13.58 años. El 75.75% fue de género masculino. La media del tiempo entre el inicio de síntomas y el diagnóstico fue de 9.53 semanas. En 16 (48.48%) pacientes hubo antecedente de cardiopatía, la más frecuente fue fiebre reumática (37.5%). La clínica más común fue soplo cardiaco (93.9%), fiebre (75.75%) y síntomas constitucionales (63.6%). La válvula más afectada por vegetaciones fue la válvula aórtica (60.6%). En 40.7% de casos hubo hemocultivo positivo, siendo Streptococo viridans el microorganismo más frecuentemente aislado (54.5%). La tasa de letalidad fue de 6%. Conclusiones: El perfil de la EI en el presente estudio es similar al de estudios recientes realizados en otros países, sobre todo en países de Sudamérica, donde la fiebre reumática y el Streptococo viridans continúan siendo la cardiopatía predisponente y el microorganismo más frecuente, a pesar de las nuevas tendencias acaecidas en éstas.

Objectives: To describe the clinical, epidemiologic and microbiologic characteristics of patients with infective endocarditis (IE). Methods: We perform a retrospective and analytical study. We reviewed the medical records of patients diagnosed with probable or definitive IE according to the modified Duke criteria, hospitalized at the National Hospital A. Loayza between January 2003 and December 2007. We determined the prevalence of IE and the frecuency of diagnostic criteria, clinical, echocardiographic and microbiologic characteristcs, complications, treatment and letality rate of IE. Results: We included 33 cases of IE, of which 18 (54.50%) had a definitive diagnosis. The incidence calculated over five years was 0.91 cases per 1 000 hospitalizations. Mean age was 40.1±13.58 years, and 75.5% were males. The average time between symptom onset and was 9.53 weeks. Sixteen (48.48%) patients had a history of heart disease, rheumatic fever was the most frequent (37.50%). Heart murmur (93.97%), fever (75.75%), and constitutional symptoms (63.60%) were the most common clinical presentation. The aortic valve was the most affected by vegetations (60.60%). In 40.7% of cases a positive blood culture was found, with Streptococo viridans as the most frequently isolated microorganism (54.50%). The lethality rate was 6%. Conclusions: The profile of IE in this study is similar to recents studies in other countries, especially in South America, where rheumatic fever and Streptococo viridans remain as the underlying cardiopathy and most common microorganism, although the new trends.

[Inflamatory heart diseases in childhood lebanese epidemiological study]

To study the frequency, prevalence, clinical presentation, management and out come of inflammatory heart diseases [IHD] in Lebanese children. Prospective survey of a group of children carriers [or at high risk] of an IHD [n: 156] recorded over a period of six years, between May 1[st], 1999, and April 30[th], 2005, at the National Register of Paediatric and Congential Heart Disease, Lebanese Society of Cardiology. The diagnosis was confirmed in all cases by echocardiography. Cases related to cardiac surgery were excluded. Acute rheumatic fever [ARF] is the most frequent pathology: 35.9%, followed by Kawasaki disease [KD]: 24.4%, dilated cardiomyopathy [DCM]: 22.4% pericardial effusion: 10.9% and finally infective endocarditis [IE]: 6.4%. There is a seasonal predominance for the ARF and KD during fall and early spring. Consanguineous marriage of first degree dosen't seem to be a factor predisposing for ARF and KD. ARF with carditis benefited from steroids with partial to total regresstion in 41/45 patients [91%], two patients under went valve repair or replacement, another patient died from severe pancarditis. All children affected with KD [except 2 cases] received IV immunoglobulins [2 g/kg, single dose], and coronary aneurysms were observed in 2 patients [5.3%]. Patients with DCM in whom there was a strong suspicion of viral myocarditis, were treated medically with complete recuperation of the cardiac function in 88% of cases. Among the patients with pericardial effusion, 3 needed urgent drainage because of a tamponnade. A child with IE was operated of his mitral valve and another one with cerebral palsy had a fatal outcome. No case of cardiac disease associated with HIV infection was found. In Lebanon, ARF remains the main cause of IHD during childhood, before KD. Currently, non-surgical treatments are highly efficient. Delayed diagnosis increased morbidity. Efforts are necessary for early recongnition and primary prevention

Endocarditis infecciosa en adictos a drogas intravenosas / Infective endocarditis in intravenous drug addicts

La endocarditis infecciosa es una complicación frecuente en sujetos adictos a drogas intravenosas, y es evidente que es un problema que se ha incrementado en años recientes como consecuencia al número cada vez mayor de adictos a drogas: Del primero de mayo de 1994 al primero de mayo de 1998, se revisaron retrospectivamente, los expedientes de los pacientes que ingresaron, al HGR No. 20 IMSS en la Cd. de Tijuana B.C., con el diagnóstico de alta probabilidad de endocarditis infecciosa. Todos tenían el antecedente de uso de drogas intravenosas. Se analizaron los datos acerca de su historia clínica, hallazgos microbiológicos, ecocardiográficos y quirúrgicos. Se revisó la evolución intrahospitalaria. Se incluyeron a 8 pacientes en el estudio. En ninguno se demostró historia previa de cardiopatía. La infección involucró a las válvulas cardíacas derechas en 62.5 por ciento, ambas válvulas cardíacas izquierdas en 12.5 por ciento, solamente una de las válvulas izquierdas 25 por ciento, y afectó de manera simultánea a las válvulas cardíacas derechas e izquierdas en 12.5 por ciento de los casos. Staphylococcus aureus fue el germen causal en el 50 por ciento de los casos. La sobrevida de la endocarditis infecciosa de cavidades derechas fue del 75 por ciento y sólo 25 por ciento requirió de intervención quirúrgica. La mortalidad de la infección en cavidades izquierdas fue del 75 por ciento y del 100 por ciento en infección de ambas cavidades. La endocarditis infecciosa en adictos a drogas, tiene en general un pronóstico favorable, cuando afecta a las cavidades derechas. Sin embargo, la morbi-mortalidad se incrementa cuando la infección afecta a cavidades izquierdas, y de manera simultánea en ambos lados del corazón.