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Journal of the American College of... Aug 2023
Topics: Humans; Aortic Valve; Heart Valve Prosthesis
PubMed: 37587588
DOI: 10.1016/j.jacc.2023.04.061 -
Expert Review of Cardiovascular Therapy 2024Infective endocarditis (IE) is an increasingly important condition with significant morbidity and mortality. With advancements in cardiovascular interventions including... (Review)
Review
INTRODUCTION
Infective endocarditis (IE) is an increasingly important condition with significant morbidity and mortality. With advancements in cardiovascular interventions including prosthetic valve implantation and utilization of intracardiac devices, the prevalence of IE is rising in the modern era. Early detection and management of this condition are critical.
AREAS COVERED
This review presents a contemporary review of the applications of multi-modality imaging in IE, taking a comparative approach of the various imaging modalities.
EXPERT OPINION
Transthoracic and transesophageal echocardiography are essential imaging modalities in establishing the diagnosis of IE, as well as evaluating for complications of IE. Other imaging modalities such as cardiac computed tomography and nuclear imaging play an important role as adjuvant imaging modalities for the evaluation of IE, particularly in prosthetic valve IE and cardiovascular implantable device associated IE. It is crucial to understand the strengths, weaknesses, and clinical application of each imaging modality, to improve the diagnosis, management, and outcomes of patients with IE.
Topics: Humans; Fluorodeoxyglucose F18; Endocarditis; Multimodal Imaging; Heart; Heart Valve Prosthesis; Endocarditis, Bacterial
PubMed: 37996246
DOI: 10.1080/14779072.2023.2288152 -
JAMA Network Open Jul 2023It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed...
IMPORTANCE
It is suggested that patients with Cutibacterium acnes endocarditis often present without fever or abnormal inflammatory markers. However, no study has yet confirmed this statement.
OBJECTIVE
To assess the clinical characteristics and outcomes of patients with C acnes endocarditis.
DESIGN, SETTING, AND PARTICIPANTS
A case series of 105 patients presenting to 7 hospitals in the Netherlands and France (4 university hospitals and 3 teaching hospitals) with definite endocarditis according to the modified Duke criteria between January 1, 2010, and December 31, 2020, was performed. Clinical characteristics and outcomes were retrieved from medical records. Cases were identified by blood or valve and prosthesis cultures positive for C acnes, retrieved from the medical microbiology databases. Infected pacemaker or internal cardioverter defibrillator lead cases were excluded. Statistical analysis was performed in November 2022.
MAIN OUTCOMES AND MEASURES
Main outcomes included symptoms at presentation, presence of prosthetic valve endocarditis, laboratory test results at presentation, time to positive results of blood cultures, 30-day and 1-year mortality rates, type of treatment (conservative or surgical), and endocarditis relapse rates.
RESULTS
A total of 105 patients (mean [SD] age, 61.1 [13.9] years; 96 men [91.4%]; 93 patients [88.6%] with prosthetic valve endocarditis) were identified and included. Seventy patients (66.7%) did not experience fever prior to hospital admission, nor was it present at hospitalization. The median C-reactive protein level was 3.6 mg/dL (IQR, 1.2-7.5 mg/dL), and the median leukocyte count was 10.0 × 103/µL (IQR, 8.2-12.2 × 103/µL). The median time to positive blood culture results was 7 days (IQR, 6-9 days). Surgery or reoperation was indicated for 88 patients and performed for 80 patients. Not performing the indicated surgical procedure was associated with high mortality rates. Seventeen patients were treated conservatively, in accordance with the European Society of Cardiology guideline; these patients showed relatively high rates of endocarditis recurrence (5 of 17 [29.4%]).
CONCLUSIONS AND RELEVANCE
This case series suggests that C acnes endocarditis was seen predominantly among male patients with prosthetic heart valves. Diagnosing C acnes endocarditis is difficult due to its atypical presentation, with frequent absence of fever and inflammatory markers. The prolonged time to positivity of blood culture results further delays the diagnostic process. Not performing a surgical procedure when indicated seems to be associated with higher mortality rates. For prosthetic valve endocarditis with small vegetations, there should be a low threshold for surgery because this group seems prone to endocarditis recurrence.
Topics: Humans; Male; Middle Aged; Endocarditis, Bacterial; Heart Valve Prosthesis; Endocarditis; Communicable Diseases; Electrocardiography
PubMed: 37436747
DOI: 10.1001/jamanetworkopen.2023.23112 -
Current Problems in Cardiology Aug 2023Prevalence of congenital heart diseases worldwide is around 9 per 1000 newborns, 20% of which affect the pulmonary valve or right ventricular outflow tract. As survival... (Review)
Review
Prevalence of congenital heart diseases worldwide is around 9 per 1000 newborns, 20% of which affect the pulmonary valve or right ventricular outflow tract. As survival after surgical repair of these defects has improved over time, there is the need to address the long-term issues of older children and young adults with "repaired" congenital heart diseases. In recent decades, the most used types of valves are the mechanical and bioprosthetic valves. Despite improving patients' quality of life, these effects are suboptimal due to their limitations, such as the inability to grow and adapt to hemodynamic changes. These issues have led to the search for living valve solutions through tissue engineering to respond to these challenges. This article aims to review the performance of traditional pulmonary valves and understand how tissue engineering-based valves can improve the management of these patients.
Topics: Infant, Newborn; Child; Young Adult; Humans; Adolescent; Pulmonary Valve; Tissue Engineering; Heart Valve Prosthesis Implantation; Quality of Life; Treatment Outcome; Heart Defects, Congenital; Heart Valve Prosthesis; Bioprosthesis
PubMed: 35460681
DOI: 10.1016/j.cpcardiol.2022.101212 -
The American Journal of Medicine Dec 2023
Topics: Humans; Aortic Valve; Endocarditis; Endocarditis, Bacterial; Aorta; Heart Valve Prosthesis; Prosthesis-Related Infections
PubMed: 37572744
DOI: 10.1016/j.amjmed.2023.07.023 -
JACC. Cardiovascular Interventions Dec 2023
Topics: Humans; Treatment Outcome; Mitral Valve; Heart Valve Prosthesis Implantation; Mitral Valve Insufficiency; Heart Valve Prosthesis; Cardiac Catheterization
PubMed: 37999710
DOI: 10.1016/j.jcin.2023.10.047 -
Journal of Cardiology Aug 2024The tricuspid valve is known as "the forgotten valve". Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. TR is often late in the course of the... (Review)
Review
The tricuspid valve is known as "the forgotten valve". Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease. TR is often late in the course of the disease when it becomes symptomatic, often being a marker of late-stage chronic heart failure with a poor prognosis and high mortality rate at long-term follow-up. Despite the clear correlation between TR and mortality, most TR patients are under-treated. Neither pharmacologic nor surgical treatment demonstrates a significant survival benefit. Isolated tricuspid valve surgery has the highest mortality rate of all valve surgeries. Therefore, there is an urgent clinical need for minimally invasive therapies to meet the needs of patients with TR. In recent years, a variety of transcatheter tricuspid valve interventions representing less invasive alternatives to surgery have shown promising results, which bring hope to patients with severe TR. The purpose of this review is to provide a complete and updated overview on current transcatheter tricuspid valve interventions and clinical evidence.
Topics: Humans; Tricuspid Valve Insufficiency; Tricuspid Valve; Cardiac Catheterization; Heart Valve Prosthesis Implantation; Heart Valve Prosthesis
PubMed: 38583664
DOI: 10.1016/j.jjcc.2024.04.001 -
Communications Biology Oct 2023Heart valve disease is a major cause of mortality and morbidity worldwide with no effective medical therapy and no ideal valve substitute emulating the extremely...
Heart valve disease is a major cause of mortality and morbidity worldwide with no effective medical therapy and no ideal valve substitute emulating the extremely sophisticated functions of a living heart valve. These functions influence survival and quality of life. This has stimulated extensive attempts at tissue engineering "living" heart valves. These attempts utilised combinations of allogeneic/ autologous cells and biological scaffolds with practical, regulatory, and ethical issues. In situ regeneration depends on scaffolds that attract, house and instruct cells and promote connective tissue formation. We describe a surgical, tissue-engineered, anatomically precise, novel off-the-shelf, acellular, synthetic scaffold inducing a rapid process of morphogenesis involving relevant cell types, extracellular matrix, regulatory elements including nerves and humoral components. This process relies on specific material characteristics, design and "morphodynamism".
Topics: Tissue Engineering; Heart Valve Prosthesis; Quality of Life; Heart Valves; Tissue Scaffolds
PubMed: 37805576
DOI: 10.1038/s42003-023-05383-z -
Journal of the American College of... Apr 2024This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective... (Review)
Review
This focused review highlights the latest issues in native valve infective endocarditis. Native valve disease moderately increases the risk of developing infective endocarditis. In 2023, new diagnostic criteria were published by the Duke-International Society of Cardiovascular Infectious Diseases group. New pathogens were designated as typical, and findings on computed tomography imaging were included as diagnostic criteria. It is now recognized that a multidisciplinary approach to care is vital, and the role of an "endocarditis team" is highlighted. Recent studies have suggested that a transition from intravenous to oral antibiotics in selected patients may be reasonable, and the role of long-acting antibiotics is discussed. It is also now clear that an aggressive surgical approach can be life-saving in some patients. Finally, results of several recent studies have suggested there is an association between dental and other invasive procedures and an increased risk of developing infective endocarditis. Moreover, data indicate that antibiotic prophylaxis may be effective in some scenarios.
Topics: Humans; Endocarditis; Endocarditis, Bacterial; Tomography, X-Ray Computed; Anti-Bacterial Agents; Antibiotic Prophylaxis; Heart Valve Prosthesis; Fluorodeoxyglucose F18; Positron Emission Tomography Computed Tomography
PubMed: 38599719
DOI: 10.1016/j.jacc.2023.12.043 -
Current Problems in Cardiology Jul 2024Mechanical prosthetic valve thrombosis (MPVT) is a common complication of valvular implantations. This study compared the efficacy and safety of different treatments for... (Review)
Review
Mechanical prosthetic valve thrombosis (MPVT) is a common complication of valvular implantations. This study compared the efficacy and safety of different treatments for MPVT. A systematic search of electronic databases identified studies evaluating surgical, anticoagulant, and thrombolytic therapies. Although several studies of different types have been conducted to evaluate the efficacy of these treatment strategies the lack of randomized controlled trials has resulted in the inability to make a definitive conclusion about the pros and cons of these treatments. Recent treatments, such as slow and ultraslow infusion of thrombolytics, showed comparable efficacy and lower complication rates than traditional methods. Inadequate anticoagulant use is a major risk factor for MPVT, highlighting the importance of prevention. Treatment selection should be individualized based on patient factors and available expertise. Overall, slow and ultraslow infusion of thrombolytics may be a promising treatment option for MPVT.
Topics: Humans; Heart Valve Prosthesis; Thrombosis; Thrombolytic Therapy; Fibrinolytic Agents; Anticoagulants; Risk Factors; Heart Valve Prosthesis Implantation; Treatment Outcome
PubMed: 38729276
DOI: 10.1016/j.cpcardiol.2024.102628