Surgical interference in cases of infective endocarditis [results and outcome]

Many patients with infective endocarditis [IE] present with serious and complicated courses that lead to significant morbidity and mortality. We followed up 39 cases of IE who were referred to surgery. Our patient population was comprised of 30 males and 9 females [aged between 7 and 52 years, mean 26.8 +/- 12.9 years]. Congenital heart disease was present in 7 of the patients while rheumatic heart disease was present in 32. The patients presented with congestive heart failure [CHF] in 26, and systemic embolization in 5. Blood cultures were positive in 30 [76.9%] of the patients, while vegetations were detected by 2-dimensional echocardiography in 28 patients [71.7%]. Elective surgery was performed in 36 patients and emergency operation for systemic arterial embolizalion and/or intractable CHF in 3 patients. Four patients required re-operation for post-operative bleeding. All patients were followed up for 6 months with no evidence of re-infection. Four patients died, 2 due to intracranial bleeding from the use of anticoagulation for the mechanical valve implanted, and 2 died due to septicaemia. The remaining patients resumed normal activity. The encouraging outcome of our study suggests that surgical intervention for IE, is a relatively safe procedure for patients with complicated IE, early diagnosis and early intervention are expected to improve the morbidity and mortality of patients with IE

Major adverse cardiac events in patients undergoing percutaneous transluminal coronary angioplasty: incidence, profile and predictors

The aim of this study was to estimate the incidence of the major adverse cardiac events [MACE] in patients undergoing percutaneous transluminal coronary angioplasty [PTCA] and detect the possible predictors of these events. The study included 11 patients underwent PTCA. Seventy-three patients were presented with unstable angina, 37 patients with stable angina and one patient had post-infarction angina. MACE included death, myocardial infarction and emergency bypass surgery during or within 24 hours of the procedure. A procedural success was achieved in 80.2% of the patients. Failed PTCA occurred in 11.7% of the patients. MACE occurred in nine patients. Three patients died, four developed myocardial infarction and two patients were referred for emergency bypass surgery. MACE occurred in 12.3% of the patients with unstable angina versus 0.0% of those with stable angina. The lesion class was the best predictor of MACE in this study by univariate analysis. Balloon to artery ratio in patients with and without MACE was 1.36 +/- 0.52 and 1.01 +/- 0.18