Staphylococcus coagulasa negativos como causantes de endocarditis en un recién nacido pretérmino / Neonatal coagulase negative Staphylococcus as a cause of endocarditis / Staphylococcus coagulase negativa como causa de endocardite em recém-nascido prematuro

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.

Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.

Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.

Huge Candida albicans normal native tricuspid valve endocarditis

Fungal endocarditis has become an important infection associated with medical progress and the modern lifestyle. In particular, Candida spp. is a rare but important cause of infective endocarditis. We report the case of a 28-year-old woman­quadriplegic and bedridden from birth­who died after repeated episodes of pneumonia treated with different regimens of intravenous antibiotics. A medico legal autopsy was performed, which diagnosed severe Candida native valve infective endocarditis (CIE). This case report illustrates the prolonged use of antibiotic treatment as a possible risk factor for the development of CIE. We also considered how the bedridden condition and the presence of a central venous catheter may be additional risk factors for the development of this entity. Finally, we examined the absence of peripheral embolization in the setting of endocarditis of the right side of the heart.

Conferencia clínico-patológica (CPC): paciente con malformación cardíaca congénita y endocarditis infecciosa / Clinico-pathological conference (CPC): patient with congenital heart malformation and infective endocarditis / Conferência clínico patológica (CPC): paciente com malformação cardíaca congênita e endocardites infecciosa

Se presenta el caso de un hombre de 17 años, sin antecedentes de importancia, quien consultó por deterioro de su clase funcional, fatigabilidad y disnea, de un mes de evolución, además de fiebre y síndrome de respuesta inflamatoria sistémica (SIRS), en quien se documentaron una malformación congénita de novo tipo situs inversus con levocardia y una comunicación interventricular (CIV), asociadas a transposición de grandes vasos; durante la hospitalización recibió varios tratamientos con antibióticos sin aislamiento microbiológico ni identificación de la causa de su descompensación hemodinámica. En el examen posmortem se identificó endocarditis por Aspergillus spp., con embolia a diferentes órganos.

We present the case of a 17 year-old-man, with no remarkable past medical history, who had a one month history of worsening functional class, fatigability and dyspnea, in addition to fever and systemic inflammatory response syndrome (SIRS); a de-novo congenital heart malformation, situs inversus type, with levocardia and a ventricular septal defect (VSD) associated with transposition of great vessels were documented. During hospitalization he received several antibiotic treatments without microbiological isolation or identification of the cause of hemodynamic decompensation. An Aspergillus endocarditis with emboli to different organs was identified in the post-mortem examination.

Se apresenta o caso de um homem de 17 anos, sem antecedentes de importância, quem consultou por um mês de evolução de deterioração de sua classe funcional, fatigabilidade e dispneia, além de febre e síndrome de resposta inflamatória sistémica (SIRS) em quem se documentaram uma malformação congênita de novo tipo situs inversus com levocardia e uma comunicação interventricular (CIV), associada a transposição de grandes copos; durante a hospitalização recebeu vários tratamentos com antibióticos sem isolamento microbiológico nem identificação da causa de sua descompensação hemodinâmica. No exame post-mortem se identificou endocardites por Aspergillus spp., com embolia a diferentes órgãos.

Transcatheter Intervention for Infantile Hepatic Hemangioendothelioma with Amplatzer Duct Occluder II.

Introduction: Infantile Hepatic hemangioendothelioma is characterized by multifocal benign vascular dilatations involving the liver. The clinical course depends on tumor size, localization and complications. Case Report: 15 days old neonate with stormy postnatal period was referred for intractable congestive cardiac failure. Transthoracic 2D echocardiography showed multiple vegetations on all the four valves, noncompaction of left ventricle with multiple vascular channels in left lobe of liver. Computed tomography angiogram showed 58x29x50 mm markedly enhancing lesion in left lobe of liver suggestive of infantile hepatic hemangioendothelioma. The neonate was treated for bacterial endocarditis. Later 6x6 Amplatzer duct occluder II was parked in hepatic vein, then gel foam and polyvinyl chloride particles were injected into infantile hepatic hemangioendothelioma. Cardiac failure resolved with marked regression of lesion. Discussion: Infantile hepatic hemangioendothelioma is a rare anomaly causing heart failure in neonate causing death in up to 70% of untreated infants without adequate regression of lesion. Therefore aggressive treatment is warranted. For the first time in the world, we report a case of infantile hepatic hemangioendothelioma in a neonate, with pump failure due to noncompaction of left ventricle and vegetations on all four valves, successfully treated by combination of transcatheter deployment of Amplatzer duct occluder II to occlude the venous end and hand injection of gel foam and polyvinly chloride particles from the aortic end to close the feeder artery. Conclusion: The combination of closure of hepatic vein by Amplatzer duct occluder II and injection of gel foam and polyvinyl chloride particles is safe and effective in infantile hepatic hemangioendothelioma in neonate with heart failure.

Late outcome analysis of the Braile Biomédica® pericardial valve in the aortic position / Avaliação dos resultados tardios da bioprótese de pericárdio bovino Braile Biomédica® em posição aórtica

Objective: Aortic valve replacement with Braile bovine pericardial prosthesis has been routinely done at the Heart Institute of the Universidade de São Paulo Medical School since 2006. The objective of this study is to analyze the results of Braile Biomédica® aortic bioprosthesis in patients with aortic valve disease. Methods: We retrospectively evaluated 196 patients with aortic valve disease submitted to aortic valve replacement with Braile Biomédica® bovine pericardial prosthesis, between 2006 and 2010. Mean age was 59.41±16.34 years and 67.3% were male. Before surgery, 73.4% of patients were in NYHA functional class III or IV. Results: Hospital mortality was 8.16% (16 patients). Linearized rates of mortality, endocarditis, reintervention, and structural dysfunction were 1.065%, 0.91%, 0.68% and 0.075% patients/year, respectively. Actuarial survival was 90.59±2.56% in 88 months. Freedom from reintervention, endocarditis and structural dysfunction was respectively 91.38±2.79%, 89.84±2.92% and 98.57±0.72% in 88 months. Conclusion: The Braile Biomédica® pericardial aortic valve prosthesis demonstrated actuarial survival and durability similar to that described in the literature, but further follow up is required to assess the incidence of prosthetic valve endocarditis and structural dysfunction in the future. .

Objetivo: A troca valvar aórtica por substitutos biológicos de pericárdio bovino Braile é realizada rotineiramente no Instituto do Coração da Faculdade de Medicina da USP desde 2006. O objetivo deste estudo é analisar os resultados da utilização da prótese aórtica Braile Biomédica® em pacientes com doença valvar aórtica. Métodos: Foram analisados, retrospectivamente, 196 pacientes portadores de valvopatia aórtica submetidos à troca valvar aórtica por prótese biológica de pericárdio bovino Braile Biomédica® entre 2006 e 2010. A idade média foi de 59,41±16,34 anos e 67,3% eram do sexo masculino. No pré-operatório, 73,4% dos pacientes estavam em classe funcional III ou IV. Resultados: A mortalidade hospitalar foi 8,16% (16 pacientes). As taxas linearizadas de óbito, endocardite, reoperação e disfunção estrutural foram de 1,065%, 0,91%, 0,68% e 0,075% pacientes/ano, respectivamente. A sobrevida actuarial foi de 90,59±2,56% em 88 meses. A curva livre de reoperação, endocardite e disfunção estrutural foi respectivamente de 91,38±2,79%, 89,84±2,92% e 98,57±0,72% em 88 meses. Conclusão: O implante da prótese aórtica de pericárdio bovino Braile Biomédica® demonstrou sobrevida e durabilidade compatível com a literatura, porém maior seguimento é necessário para avaliar a incidência de endocardite e disfunção estrutural no futuro. .

Aerococcus viridans como agente etiológico de endocardite em valva nativa / Aerococcus viridans as etiological agent in native valve endocarditis

Aerococcus viridans é um patógeno humano incomum e endocardite por este agente na literatura é rara. Relata-se o caso de paciente feminina, 56 anos,hospitalizada devido a quadro de picos febris que, após investigação, foi diagnosticada através dos critérios clínicos de Duke, com endocardite em valva nativa. Foi evidenciado através das hemoculturas o crescimento de A. viridans, sendo o primeiro casoreportado no Brasil. Há relatos desse agente também em infecções urinárias, bacteremia, meningite e artrite séptica. No presente caso, a paciente teve melhorresposta clínica após o início da ampicilina, confirmando alguns artigos que orientam o tratamento com penicilinas.

Aerococcus viridans is an uncommon human pathogen and reports of endocarditis caused by this agent arerare in the literature. This clinical case study describes a 56 year-old female patient admitted to hospital forspiking fevers. After investigation, this was diagnosed as native valve endocarditis, based on the Duke clinicalcriteria and confirmed through the growth of A. viridans in blood cultures, making this the first reported case in Brazil. There are also reports of thisagent in urinary tract infections, bacteremia, meningitis and septic arthritis. In this case, the patient had a better clinical response after starting on ampicillin, confirmed by some articles that recommend treatment withpenicillins.

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...

Endocardite marântica e adenocarcinoma de sítio primário oculto / Marantic endocarditis and adenocarcinoma of unknown primary site / Endocarditis marántica y adenocarcinoma de sitio primario desconocido

A endocardite trombótica não bacteriana é caracterizada pela deposição de trombos e fibrina sobre valvas cardíacas normais ou degeneradas na ausência de germes. A patologia está relacionada a estados inflamatórios crônicos, com maior incidência de fenômenos embólicos quando comparada à endocardite infecciosa. Os autores relatam o caso de um paciente masculino, 63 anos, com adenocarcinoma de sítio primário oculto e embolia sistêmica.

Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.

La endocarditis trombótica no bacteriana se caracteriza por el depósito de trombos de fibrina en las válvulas cardíacas normales o degenerados en ausencia de gérmenes. La patología se relaciona con estados inflamatorios crónicos, con una mayor incidencia de fenómenos embólicos cuando comparada a endocarditis infecciosa. Los autores refieren el caso de un paciente varón, de 63 años con adenocarcinoma de sitio primario desconocido y la embolia sistémica.

Prosthetic aortic valve endocarditis due to Ochrobactrum anthropi.

Ochrobactrum anthropi is an emerging pathogen increasingly affecting the immunocompromised host. Only four cases of infective endocarditis have been documented in literature. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems. We report a case of prosthetic valve endocarditis secondary to Ochrobactrum anthropi infection; the host was temporarily immunocompromised due to disseminated herpes zoster after surgery.

Endocardite de Libman-Sacks, anticorpos antifosfolípides e trombose arterial no lúpus ertitematoso sistêmico: relato de caso / Libman-Sacks endocarditis, antiphospholipid antibodies and arterial thrombosis in systemic lupus erythematosus: case report

Relato de caso de paciente de 38 anos, feminina, com lúpus eritematoso sistêmico (LES) que apresentou evento tromboembólico arterial agudo em membro inferior direito. A investigação evidenciou a presença de anticorpos antifosfolípides e vegetação asséptica em válvula mitral, endocardite de Libman-Sacks (eLS). São discutidas as possíveis causas de eventos tromboembólicos arteriais no LES, com ênfase nas recomendações atuais para diagnóstico e tratamento da eLS.

Case report of a 38-year-old female patient with systemic lupus erythematosus (SLE) who presented an acute arterial thromboembolic event in the right lower limb. Investigation showed the presence of antiphospholipid antibodies and sterile vegetation in the mitral valve, Libman-Sacks endocarditis (LSE). Possible causes of thromboembolic events in SLE are discussed, with emphasis on current recommendations for diagnosis and treatment of LSE.

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 de Libman-Sacks / Libman-Sacks endocarditis

Libman y Sacks describieron por primera vez en 1924 la presencia de lesiones valvulares en enfermos con lupus eritematoso. La endocarditis de Libman y Sacks se caracteriza por vegetaciones estériles valvulares de predominio en las válvulas mitral y aórtica. Su prevalencia es de 53 a 74 %. Se asocia con actividad lúpica y presencia de anticuerpos antifosfolípido. La ecocardiografía, en especial la transtorácica, es el estudio de elección para el diagnóstico y seguimiento, así como para evaluar el involucro valvular. El objetivo de este trabajo es presentar la imagen ecocardiográfica de un enfermo con lupus eritematoso activo portador de endocarditis de Libman-Sacks.

In 1924, Libman and Sacks described valvular lesions in patients with lupus erythematosus. Libman-Sacks valvular lesions are sterile fibrinous vegetations that preferentially develop at the left-sided heart valves. Reports of their prevalence range from 53 to 74%. Libman-Sacks endocarditis is associated with disease activity and antiphospholipid antibodies titer. Echocardiography is a useful tool for documenting valvular involvement and dysfunction as well as disease progression. Transesophageal echocardiography is superior to transthoracic echocardiography in detecting Libman-Sacks endocarditis. This report describes the echocardiographic image of Libman-Sacks endocarditis in a patient with active lupus erithematosus.

Substituição valvar isolada com próteses metálicas St. Jude Medical em posição aórtica ou mitral: seguimento de médio prazo / Sustitución valvular aislada con prótesis metálicas St. Jude Medical en posición aórtica o mitral: seguimiento de medio plazo / Isolated mitral and aortic valve replacement with the St. Jude Medical valve: a midterm follow-up

FUNDAMENTO: Em nosso meio as próteses valvares biológicas predominam, considerando-se as dificuldades relacionadas à anticoagulação, mesmo em pacientes jovens, a despeito da necessidade de repetidas operações devido à degeneração das próteses biológicas. OBJETIVO: Apresentar a evolução em médio prazo de pacientes submetidos à substituição da valva mitral ou aórtica por prótese valvar mecânica St. Jude. MÉTODOS: Foi analisada retrospectivamente a evolução dos pacientes operados entre janeiro de 1995 e dezembro de 2003 e seguidos até dezembro de 2006. RESULTADOS: Cento e sessenta e oito pacientes receberam prótese valvar mitral e 117, aórtica. A idade média de ambos os grupos foi de 45 anos. Entre os mitrais, 75 por cento tinham até 55 anos e 65 por cento eram mulheres. Entre os aórticos, 66 por cento tinham até 55 anos e 69 por cento eram homens. Considerando-se apenas mortes relacionadas às próteses valvares, a sobrevida foi de 85,6 por cento para os mitrais e de 88,7 por cento para os aórticos (p=0,698). Entre os mitrais, 97 por cento estavam livres de reoperação, e entre os aórticos 99 por cento (p=0,335). Quanto aos eventos tromboembólicos, a porcentagem de pacientes livres foi de 82 por cento entre os mitrais e de 98 por cento entre os aórticos (p=0,049), e para os eventos hemorrágicos foi de 71 por cento e 86 por cento respectivamente (0,579). Quanto à ocorrência de endocardite, 98 por cento entre os mitrais e 99 por cento entre os aórticos estavam livres ao final de 10 anos (p=0,534). CONCLUSÃO: Nossa experiência com próteses metálicas St. Jude em uma população predominantemente jovem confirma o bom desempenho desta prótese, em acordo com outras experiências publicadas.

BACKGROUND: In our country, the biological valvular prostheses predominate, considering the difficulties related to anticoagulation, even in young patients, in spite of the need for repeated operations due to the degeneration of the bioprostheses. OBJECTIVES: To report our consecutive series of recipients of isolated St Jude Medical mechanical valve prosthesis in the mitral (MVR) or aortic (AVR) position. METHODS: Data from patients operated between January 1995 and December 2003 were revised in order to determine patient survival and prosthesis-related events up to December 2006. RESULTS: One hundred sixty eight patients had MVR and 117 had AVR. In the MVR cohort, the mean age was 45 years, 75 percent were 55 years old or younger, and 65 percent were females. In the ARV cohort, the mean age was 45 years, 66 percent were 55 years old or younger and 69 percent were males. Operative mortality for AVR and MVR was 7 percent and 7.5 percent, respectively. Freedom from late mortality was 81.8 percent at 10 years for MVR and 83 percent for AVR (p=0.752). Freedom from valve-related death at 10 years for the MVR cohort and AVR was 85.6 percent and 88.7 percent, respectively (p=0.698). In the MVR cohort, the freedom from reoperation was 97 percent and 99 percent in the AVR cohort (p=0.335). Freedom from thromboembolic events was 82 percent in the MVR cohort and 98 percent in the AVR cohort (p=0.049). Freedom from bleeding was 71 percent in the MVR cohort and 86 percent n the AVR cohort (0.579). Freedom from endocarditis was 98 percent in the MVR cohort and 99 percent in the AVR cohort (p=0.534). CONCLUSIONS: This series of predominantly young adult patients undergoing isolated MVR and AVR with the St Jude Medical mechanical prosthesis confirms the good performance of this valve prosthesis in agreement with previous reports.

FUNDAMENTO: En nuestro medio, las prótesis valvulares biológicas predominan, teniendo en cuenta las dificultades relacionadas a la anticoagulación, incluso en pacientes jóvenes, pese a la necesidad de repetidas operaciones debido a la degeneración de las prótesis biológicas. OBJETIVO: Presentar la evolución en medio plazo de pacientes sometidos a la sustitución de la válvula mitral o aórtica por prótesis valvular mecánica St. Jude. MÉTODOS: Se analizó retrospectivamente la evolución de los pacientes operados entre enero de 1995 y diciembre de 2003 y seguidos hasta diciembre de 2006. RESULTADOS: Un total de 168 pacientes recibió prótesis valvular mitral y otros 117, aórtica. La edad promedio de ambos grupos fue de 45 años. Entre los mitrales, el 75 por ciento tenía hasta 55 años y el 65 por ciento era mujeres. Entre los aórticos, el 66 por ciento tenía hasta 55 años y el 69 por ciento era de varones. Teniendo en cuenta solamente las muertes relacionadas a las prótesis valvulares, la sobrevida fue del 85,6 por ciento para los mitrales y del 88,7 por ciento para los aórticos (p=0.698). Entre los mitrales, el 97 por ciento estaba libre de reoperación, y entre los aórticos el 99 por ciento (p=0,335) lo estaba. En cuanto a los eventos tromboembólicos, el porcentaje de pacientes libres fue del 82 por ciento entre los mitrales y del 98 por ciento entre los aórticos (p=0,049), y para los eventos hemorrágicos fue del 71 por ciento y el 86 por ciento respectivamente (0,579). En cuanto a la ocurrencia de endocarditis, el 98 por ciento entre los mitrales y el 99 por ciento entre los aórticos estaba libre al final de 10 años (p=0.534). CONCLUSIÓN: Nuestra experiencia con prótesis metálicas St. Jude en una población predominantemente joven confirma el buen desempeño de esta prótesis, según otras experiencias publicadas.

Prevention of infective endocarditis in dental practice: past, present, and future perspectives

The aim of this paper is to highlight the importance of Infective endocarditis, the life threatening risk situation in our clinical practice. Our profession has witnessed a great evolution of variable prophylactic antibiotic regimens. The lack of evidence based clinical recommendations for IE prophylaxis has always been in question among professionals. It is interesting to know that in past one decade, there is a major change in this area. Recently the British recommendations have stirred the thought process. The American Heart Associations [AHA] recommendations are World widely accepted. Recently Australian multidisciplinary group has issued supportive/explanatory recommendations in line with the American Heart Association's recommendations The professionals are free to choose any of those, but the ATM are more cautions in protecting professionals and giving comfort level to patients rather than departure from the antibiotic prophylactic regimens. The review paper has covered briefly, the history of Infective endocarditis, past antibiotic regimens, present recommendations and future perspectives Within the limitations of this review, it is hoped that vigilant dental professionals would keep themselves abreast with the updated contemporary guidelines for the safety, quality of life and care of their patients

Infective endocarditis at a hospital in Saudi Arabia: epidemiology, bacterial pathogens and outcome

Data on infective endocarditis prevalence, epidemiology and etiology from Saudi Arabia and the Gulf region are sparse. We undertook this study to describe the pattern and the causative agents of endocarditis at a hospital in Saudi Arabia. We conducted a retrospective analysis of all reported endocarditis cases at the Dhahran Health Center from January 1995 to December 2008. Of the 83 cases of endocarditis, 54 [65%] were definite endocarditis and the remaining 29 [35%] were possible endocarditis based on the Duke criteria. Patients with definite endocarditis included 39 males and 15 females [ratio of 2.6:1] with a mean age [SD] of 59.7 [18.2] years. Of the definite endocarditis cases, native valve endocarditis occurred in 44 [81.5%] cases of and prosthetic valve endocarditis was observed in 10 [18.5%]. The most commonly involved valves were mitral [n=24; 44.4%] and aortic [n=20; 39.2%]. The most common organisms were S aureus [n=23; 42.6%], Enterococcus faecalis [n=12; 22.2%] and viridans streptococci [n=9; 16.7%]. Surgical intervention was required in 17 [31.4%] cases and the in-hospital mortality rate was 29.4% [n=15]. Of all the patients, 3 [5.5%] had embolic stroke as a complication. Native valve endocarditis is the predominant type of endocarditis. The patients were older adults and the most common organisms were S aureus, E faecalis and viridans streptococci

Endocarditis relacionada a cables de marcapasos o cardiodesfibriladores implantables / Endocarditis of pacemaker or implantable cardioverter-defibrillator leads

Antecedentes: Dentro del síndrome de endocarditis infecciosa, se incluyen la infección de dispositivos endovasculares. el objetivo de la presentación fue avaluar las características clínicas y la evolución de la endocarditis relacionada a dispositivos electrónicos endovasculares. Casos clínicos: entre 2002 - 2007 fueron identificados 7 pacientes con edad promedio de 56,5 años. La presentación clínica fue en el 85,7% fiebre de origen desconocido, con un promedio de 28 días de evolución del cuadro. Los germenes aislados fueron estafilococo coagulasa negativo en 6 pacientes y estafilococo aureus en 1 paciente. El tratamiento se baso en la extracción del sistema y terapia antibiótica, salvo 1 caso que solo recibió tratamiento antibiótico. Hubo 2 (28,5%) muertes intrahospitalarias durante el seguimiento. Conclusión: La endocarditis relacionada a dispositivos es una entidad con elevada mortalidad. el diagnóstico temprano y la extracción del sistema son de vital importancia para el tratamiento y pronóstico.

BACKGROUND: Infective endocarditis includes the endovascular devices infection. The main objective was to evaluate the clinical characteristics and evolution of the endocarditis related to electronics devices. CASE REPORTS: Between 2002 - 2007 periods were identified 7 patients, age average of 56.5 years. The clinical presentation was fever of unknown origin in 85.7%, with a mean of 28 days of evolution. The microbiology isolated was coagulase-negative staphylococci in 6 patients and staphylococcus aureus in 1 patient. The treatment was complete system extraction and antibiotic therapy, except in 1 case that only received antibiotics. There were 2 deaths (28,5%) during in hospital follow-up. CONCLUSION: The endocarditis related to devices is a disease with high mortality. Early diagnosis and system extraction are very important for the treatment and prognosis.

Long-term Experience with the Bjork-Shiley Monostrut Tilting Disc Valve

The Bjork-Shiley Monostrut valve is tilting disc mechanical valve prosthesis. This study was designed to present the long-term outcome of our experience. One hundred and thirty-seven Bjork-Shiley Monostrut valves were implanted in 101 consecutive patients from November 1983 to February 1990. There were 60 male and 41 female with mean age of 34.5 yr at the time of operation. Fifty-nine patients underwent single valve replacement, 38 had double valve, and 4 had triple valve replacement. There were six in-hospital deaths (5.9%): three from cardiopulmonary bypass weaning failure and one each from septic shock, sudden cardiac arrest, and uncontrollable bleeding. Mean duration of follow-up was 181.2+/-76.2 months. Overall survival was 86.2% at 15 yr and 83.1% at 20 yr. Patients with mitral valve replacement had 93.5% and 90.2% cumulative survival at 10 and 15 yr, respectively, while patients with aortic valve replacement had 91.1% and 86.5% cumulative survival at 10 and 15 yr. Two groups had no significant difference in survival. Double valve replacement patients had 92.2% and 84.0% survival at 10 and 15 yr, respectively. There were no significant differences in survival between the single and double valve replacement groups. Freedom from thromboembolism was noted in: 97.8%, 97.8%, 96.4% and 87.8% at 5, 10, 15 and 20 yr, respectively. Absence of endocarditis was noted in 98.6% and 94.8% at 15 and 20 yr. Absence of reoperation was 92.5% at 20 yr. In conclusion, the Bjork-Shiley Monostrut valve is reliable, with a similar incidence of valve-related morbidity as in other mechanical valves.