A Case of Bioprosthetic Mitral Valve Endocarditis with Severe Stenosis.

A 29-year-old female with a history of bioprosthetic mitral valve replacement was admitted with fever, chills, and shortness of breath of two weeks duration. Transthoracic echocardiography revealed a thickened bioprosthetic mitral valve with a 26 mmHg mean gradient consistent with severe mitral stenosis and associated large vegetation. Blood cultures demonstrated no growth. The patient underwent repeat mitral valve replacement surgery. At the time of operation, diffuse mitral valve thickening was observed, causing decreased mobility in both cusps with vegetation covering both sides of the valve. PCR with 16s rRNA sequencing of the tissue specimen revealed Gemella species DNA. Her recovery period was uneventful. Infective endocarditis very rarely causes obstructive/functional stenosis. When present, fungal organisms are typically implicated. These patients often present acutely with distinctive clinical evidence of obstruction, and they usually demonstrate rapid deterioration. Prompt diagnoses and timely surgery are essential.

Varicocele: tissue stress in the etiology.

BACKGROUND/AIM: It is accepted that red blood cell distribution width (RDW) is a novel prognostic marker that reflects oxidative stress and chronic inflammation. In this study, we aimed to investigate the correlation between RDW and varicocele, the etiology of which has not fully elucidated yet. This study also aimed to study the mean platelet volume (MPV) values of the patient and control group. MATERIALS AND METHODS: RDW and MPV levels were measured in 50 varicocele subjects (group 1) and 48 healthy controls (group 2) from January 2012 to January 2014, retrospectively. RESULTS: MPV levels were significantly higher in group 1 than in group 2 (P < 0.001). Although the relationship was weak, the patients with varicocele had significantly lower RDW values than did the controls (r: 0.24 P = 0.026). Positive correlations were not found between varicocele grade and MPV and RDW values (P < 0.05). CONCLUSION: Higher MPV values are associated with increased odds of developing varicocele.

Role of serum high density lipoprotein levels and functions in calcific aortic valve stenosis progression.

BACKGROUND: Clinical and epidemiological data well defines the role of atherosclerotic risk factors in pathogenesis of aortic stenosis. Especially dyslipidemia with elevated total and LDL cholesterol levels exerts certain histopathological changes on calcified valve tissue. Exact role of HDL in this process is not known. OBJECTIVE: To evaluate the lipid profiles of patients with mild aortic valve stenosis with special focus on HDL; HDL subspecies, serum apoA1 levels, HDL related PON1 and PAF-AH enzyme activities and to correlate this with disease progression rates. METHOD: 42 patients (26 female; 16 male), with calcific aortic valve stenosis were enrolled in the study. Serum fasting lipid parameters, HDL subspecies (HDL2, HDL3), serum apoA1 levels and HDL related PON1 and PAF-AH enzyme activities were determined. All participants underwent detailed follow-up transthoracic echocardiography examination. RESULTS: Among 42 study participants mean serum total cholesterol level was 195 ± 27.3 mg/dl, LDL-c level was 123 ± 19.1 mg/dl, HDL-c level was 44 ± 10.3 mg/dl and total cholesterol/HDL-c ratio was 4.64 ± 1.13. Basal peak aortic jet velocity (Vmax2) was 2.67 ± 0.39 m/sec, mean pressure gradient (Pmean2) was 15.6 ± 5.5 mmhg. Annual progression rate in peak aortic jet velocity (Vmax) was 0.23 ± 0.17 m/sec, in mean pressure gradient (Pmean) was 3 ± 2.1 mmhg. Annual progression rate in Pmean was most strongly correlated with serum HDL-c level and total/HDL-c ratio (r=-0.528 and 0.505; <0.001 and 0.001 respectively). Progression in Vmax values was positively correlated with serum LDL-c level and total/HDL-c ratio while negatively correlated with serum HDL-c levels (r=0.328, 0.499 and -0.464; P=0.034, 0.001 and 0.002 respectively). Among HDL subspecies HDL2 was the predominant type. HDL2 levels were found to be positively correlated with progression rates. There was no significant correlation between apolipoprotein A1 level and annual progression rate. Serum PON1 activity level was determined to be negatively correlated to doppler echocardiographic progression parameters while HDL related PAF-AH activity was independent of disease progression. CONCLUSION: Present study demonstrated a positive correlation between disease progression and serum total cholesterol/HDL-c ratio. Serum HDL-c level was inversely correlated with hemodynamic progression. The majority of HDL was HDL2 subtype. Among HDL related enzymes PON1 enzyme activity exhibited an inverse correlation with disease progression.