OBJECTIVES
We previously reported a possible but unusual prosthetic-valve infective endocarditis (PV-IE) occurring on a Cryolife O'Brien Stentless Porcine Xenograft (CLOB) (anatomic damages ...suggestive of IE but negative inflammatory and microbiological markers). We reviewed all cases of aortic PV-IE admitted in our institution and compared the clinical presentation, bacteriological and echocardiographic features according to the type of prosthesis.
METHODS
Sixty consecutive cases with possible or definite aortic PV-IE (23 CLOB, 26 mechanical valve and 11 stented bioprosthesis) were admitted between 2002 and 2008.
RESULTS
Patients with CLOB had more prosthetic dehiscence (P = 0.006) and severe regurgitation (P = 0.01) than those with mechanical or stented prosthetic valves. In contrast, they had less fever (P = 0.003), lower C-reactive protein (CRP) levels (P = 0.02) and more frequently negative blood cultures (P = 0.08). Differences were due to seven patients who presented with no fever, low CRP, negative blood culture, negative valve culture and PCR when performed, despite echocardiographic features suggestive of IE (abscess or valve dehiscence). All were first operated on since 2004 when the manufacturing process changed and required a second surgery. The French Authority of Health was informed leading to the withdrawal of the CLOB from the market in 2010.
CONCLUSIONS
One-third of patients with CLOB admitted for possible or definite PV-IE presented with anatomic damages suggestive of IE but with negative inflammatory and microbiological markers. The exact aetiology remains unclear, but the present data have led to the worldwide withdrawal of prosthesis in 2010. A close follow-up of patients implanted with CLOB should be advised, especially if it has been manufactured since 2004.
Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of ...its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.
Patients with acute myocardial infarction (AMI) represent a high-risk population in which screening for abdominal aortic aneurysm (AAA) is recommended but only occasionally performed. Transthoracic ...echocardiography (TTE) may offer the unique opportunity to evaluate the cardiac function and to screen for AAA during the same examination. We aimed to evaluate the feasibility of AAA screening at bedside using a portable cardiac ultrasound (US) echo machine and to determine the prevalence of AAA in population with AMI.
The AA diameter was measured at bedside at the end of a regular TTE performed in consecutive patients admitted for AMI in the coronary care unit using a portable echo machine (Vividi, General Electric). AAA was defined by a transverse diameter of ≥ 30 mm. We prospectively enrolled 193 patients (65 ± 11 years, 77% male). Measurement of the AA diameter was feasible in 93% and the duration was 3 ± 1 min. An AAA was observed in nine patients (4.7%) and the prevalence increased with age (7.7% after 60 years and 9.2% after 65 years). No AAA was observed in patients under 50 years old. Inter-observer variability between cardiologists using the portable US system was excellent (mean difference 1.8 ± 2.0 mm) as well as the accuracy compared with measurements performed by a radiologist using a dedicated vascular US system (mean difference 1.5 ± 1.3 mm).
Overall, the prevalence of AAA was 4.7%, increased with age, and seems higher than expected in the 'same-aged population'. In regard to the simplicity, accuracy, and feasibility, screening for AAA during TTE (one cardiovascular shot) may be of value after AMI especially in elderly patients.
In patients with mitral stenosis (MS), previous studies have shown discordant results with regards to improvements in right ventricular (RV) function immediately after percutaneous mitral ...commissurotomy (PMC). Hence, the study aim was to evaluate the impact of PMC on RV function, by using Doppler-echocardiography.
A total of 41 patients with severe symptomatic MS, in sinus rhythm, who had been referred to the authors' institution for PMC, was prospectively enrolled. A group of 25 healthy age- and gender-matched subjects served as controls. Transthoracic echocardiography (TTE) was performed on the day before and at 24/48 h after PMC. The RV function was evaluated using the Tricuspid Annular Plane Excursion (TAPSE), the RV Tei index, and systolic myocardial velocities by Doppler tissue imaging peak isovolumic contraction (DTI(IVC)) and peak systolic (DTI(S)) at the lateral tricuspid annulus).
All patients but three underwent a successful PMC. The mitral valve area (MVA) was significantly increased (1.8 +/- 0.3 versus 1.1 +/- 0.2 cm2, p <0.0001), while the mean gradient (5 +/- 2 versus 10 +/- 7 mmHg, p <0.0001) and systolic pulmonary artery pressure (40 +/- 10 versus 54 +/- 21 mmHg, p = 0.0002) were decreased. Compared to healthy controls, the RV dysfunction in MS patients was authenticated by the DTI(IVC) and the Tei index (8.4 +/- 3.0 versus 11.1 +/- 2.1 cm/s, p = 0.0002 and 0.33 +/- 0.10 versus 0.18 +/- 0.10 respectively, p <0.0001), but not by DTI(S) (12.9 +/- 3 versus 12.3 +/- 1.5 cm/s, p = 0.35) or TAPSE (24 +/- 5 versus 23 +/- 3 mm, p = 0.50). After PMC, no significant change regarding RV function was observed (TAPSE: 24 +/- 5 versus 24 +/- 5 mm, p = 0.54; Tei Index: 0.33 +/- 0.10 versus 0.36 +/- 0.12, p = 0.20; DTI(IVC): 8.4 +/- 3.0 versus 9.2 +/- 3.4 cm/s, p = 0.08 and DTI(S): 12.9 +/- 3.0 versus 13.0 +/- 3.4 cm/s, p = 0.54).
The DTI(IVC) and Tei index appear to serve as the more sensitive indices of RV dysfunction in patients with MS. Immediately after a successful PMC, no significant change in Doppler echocardiographic parameters of RV function was observed. Whether late improvement in RV function can be observed, and the prognostic value of these parameters realized, deserve further investigation.
In developing countries rheumatic valve disease is the most frequently acquired cardiac disorder observed during childhood. Any valve may be affected but the mitral valve is the predominant site. ...Echocardiography has a key role in the diagnosis and treatment of these disorders. Severe rheumatic valve disease carries a high risk of morbidity and mortality. Available surgical treatments include prosthetic valve replacement and conservative surgery, which is preferable when feasible. Percutaneous mitral commissurotomy is currently the treatment of choice for mitral stenosis. Preventive strategies are needed to eliminate rheumatic fever and the valve disorders it can cause.
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