[Cardiac perforation following pacemaker implantation - a case series from Iceland]. / Rof á hjarta eftir gangráðsísetningu - íslensk tilfellaröð.

INTRODUCTION: Perforation of the heart is a serious complication following pacemaker implantation that can cause life threatening bleeding and cardiac tamponade. Here we describe five cases that were diagnosed in Iceland during a four year period. MATERIALS AND METHODS: This population-based case series includes five patients diagnosed with cardiac perforation following pacemaker insertion at Landspítali and Akureyri Hospital from January 1, 2007 to December 31, 2010. The mode of detection, treatment given and outcome were studied. RESULTS: Altogether five patients (mean age 71 years, three females) were diagnosed with cardiac perforation in Iceland during the study period, one in 2008 and four in 2009. Chest pain was the most common presenting symptom (n=4) and no patient had acute cardiac tamponade. In all five cases the diagnosis was obtained with computed tomography scan or echocardiography. No perforation was detected intraoperatively but four of the cases were diagnosed within three weeks of the operation. Three patients were treated with surgical evacuation of blood via sternotomy and suture of the perforation. In the other two cases the pacemaker leads were removed in the operating room with trans-oesophageal echocardiographic guidance. Four patients survived the treatment and were discharged but one died of pneumonia in the intensive care unit. CONCLUSION: Cardiac perforation is a serious complication and should be kept in mind in patients with chest pain following pacemaker insertion.

[Endocarditis in Iceland 2000-2009, a national survey incidence, microbiology and prognosis]. / Hjartathelsbólga á íslandi 2000-2009 - nýgengi, orsakir og afdrif.

INTRODUCTION: The objective of this study was to analyze the incidence, clinical features, microbiology and prognosis of patients with infective endocarditis (IE) in Iceland, and to compare the results with a previous study made in Iceland 1976-85. MATERIAL AND METHODS: A retrospective study including all patients diagnosed with IE in Iceland 2000-2009. Information was obtained from medical records. RESULTS: A total of 88 cases (71% men, mean age 59 years) were diagnosed and the incidence of IE was calculated 2.97/100.000 person-years. The mitral valve was infected in 35 patients (40%), aortic in 27 (31%) and tricuspid in 9 (10%). In 19 cases a prosthetic valve was infected (22%), one early (<<60 days from procedure) and 18 late. Sixteen patients were intravenous drug users. The most common causative organisms were streptococcus (33%), staphylococcus (25%) and enterococcus (16%). Surgical intervention was performed in 16 cases (18%). One and five year survival was 77% and 57% respectively. CONCLUSION: The incidence of IE in Iceland is still low compared to other countries. The clinical profile of the disease has changed since 1976-85, patients with prosthetic heart valves and intravenous drug users were more prominent than before. The microbiological spectrum has not changed much, streptococcus is still the most common pathogen, contrary to what is seen in other industrial countries where S. aureus is more frequent. Death rate is lower than before and one year survival good compared to other reports.

Congenital cardiac malformations in Iceland from 1990 through 1999.

INTRODUCTION AND BACKGROUND: About 1% of live-born children have congenital malformations of the heart. The aim of our study was to investigate the incidence of such defects in children born in Iceland during a period of 10 years, extending from 1990 through 1999. MATERIALS AND METHODS: Information about the patients was obtained from medical records from two hospitals that cover the whole country, a private clinic of pediatric cardiologists, an echocardiography database, autopsy reports, and death certificates. We investigated the distribution of specific malformations, the age at diagnosis, the symptoms leading to the diagnosis, the source of referral, and treatment and quality of life. RESULTS: Between 1990 and 1999, there were 44,013 live births in Iceland, of which 740 patients were diagnosed with congenital cardiac malformations, accounting for 1.7% of the live-born children. The distribution was made up of 338 patients with ventricular septal defect (45.7%), 90 with atrial septal defect (12.2%), 85 with patency of the arterial duct (11.5%), 48 with pulmonary valvar stenosis (6.5%), 38 with a bicuspid aortic valve (5.1%), 28 with aortic coarctation (3.8%), 22 with tetralogy of Fallot (3.0%), 14 with transposed great arteries (1.9%), 11 with aortic stenosis (1.5%), 10 with atrioventricular septal defect and common atrioventricular orifice (1.4%), 9 with mitral valvar regurgitation (1.2%), 7 with sub-aortic stenosis (0.9%), and 5 with hypoplasia of the left heart (0.7%). Extracardiac anomalies were seen in 89 patients (12.0%). Chromosomal defects were seen in 36 patients, of whom 28 had Down's syndrome. DISCUSSION: The annual incidence of diagnosis of patients with congenital cardiac malformations increased during the period of study. This was noted for minor defects, but the incidence of the major anomalies did not alter. Our observed yearly incidence, at 1.7%, was higher than noted in a previous study covering the years 1985 through 1989, and is also higher than in other population-based studies. The most likely explanation is the fact that access to pediatric cardiologists in Iceland is very good. Diagnosis, registration, and follow-up are conducted by only a few cardiologists, and take place at a single center for pediatric cardiology.