Embolization – ABC CARDIOL

ABC

Image

Fibroelastoma, an Incidentaloma Disease? – Image Cases of Fibroelastomas as Incidental Findings in Four Patients, Four Different Valves

Joana Lima Lopes et al. Antonio Freitas João Bicho Augusto

Abstract

Fibroelastomas are the second most common benign cardiac tumor. They are small avascular structures with a mean size of 9mm, ranging up to 70mm, usually attached to the heart valves’ surface (aortic and mitral are the most affected, followed by tricuspid and pulmonary valves). Their etiology is unclear, but the hypothesis of coalescence of microthrombus at the coaptation margins of valves is the most widely accepted theory. On echocardiography, they are pedicled, mobile, with a filamentous surface, and usually have a speckled appearance with echolucencies and a stippled pattern near the edges. Clinically, they may be associated with embolic phenomena; however, in most cases, the diagnosis is incidental. We present a series of four clinical cases with an incidental diagnosis of fibroelastomas across the four cardiac valves as assessed by transthoracic echocardiography (; ).

Read Full Article

ABC

Editorial

Managing Patients with Infectious Endocarditis and Neurological Complication — The Big Dilemma that Persists Until these Days

Claudio Querido Fortes et al. Natália Rodrigues Querido Fortes

Endocarditis is an extremely challenging disease, both regarding diagnosis and due to the diversity of its presentation, as well as its management, which requires an endocarditis team including professionals from different specialties. An infectious disease specialist, clinical microbiologist, cardiologist, cardiac surgeon, neurologist and imaging specialist are of the essence, and assistance from other specialists is also desirable depending on each case. Its incidence has been increasing in recent decades, especially due to population aging, the growing number of individuals undergoing renal replacement therapy, the higher frequency of patients with prosthetic valves and cardiac electrical devices and also due to the technological advances in invasive diagnostic and therapeutic methods, in addition to the current “epidemic” of recreational intravenous drugs, which have become a serious public health problem in some countries. Despite all the progress made in the diagnosis and treatment of endocarditis, its mortality remains alarmingly high. The persistence of this high mortality may be partially explained by the increase in the number of older fragile patients with multiple comorbidities and patients with prostheses.

The main objectives of the article “ Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre” are to evaluate the predictors of neurological complications in patients with infective endocarditis, the predictors of mortality in this group, and to compare the results of clinical treatment with a general practitioner and a surgeon, both among the study population, and stratifying the group of patients with neurological complications.

[…]

Read Full Article

ABC

Original Article

Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Sofia Alegria et al. Ana Marques Inês Cruz Ana Luísa Broa … Ana Rita F. Pereira Isabel João Otília Simões Hélder Pereira

Background:

Neurological complications are common in patients with infective endocarditis (IE). Recent data suggest that neurologic events are a major determinant of prognosis, and that surgery is critical in improving the outcome.

Objective:

To characterize patients with IE and neurological complications and to determine predictors of embolization to the central nervous system (CNS) and mortality.

Methods:

Retrospective analysis of patients admitted to a tertiary center with the diagnosis of IE from 2006 to 2016. Statistical significance was defined by a p-value < 0.05.

Results:

We identified 148 episodes of IE, 20% of which had evidence of CNS embolization. In patients with CNS embolization, 76% presented with ischemic stroke. During follow-up, 35% were submitted to surgery and both in-hospital and one-year mortality were 39%. These patients had longer hospitalizations, but there were no significant differences regarding mortality in patients with and without CNS embolization. The independent predictors of neurological complications were diabetes (p=0.005) and the absence of fever at presentation (p=0.049). Surgery was associated with lower mortality (0 vs. 58%; p=0.003), while patients with septic shock had a poorer prognosis (75 vs. 25%; p=0.014). In multivariate Cox regression, human immunodeficiency virus (HIV) infection was the only independent predictor of in-hospital and 1-year mortality (p=0.011 in both).

Conclusions:

In this population, embolization to the CNS was common, more often presented as ischemic stroke, and was associated with longer hospitalization, although without significant differences in mortality. In patients with CNS embolization, those submitted to surgery had a good clinical evolution, while patients with septic shock and HIV infection had a worse outcome. These results should be interpreted with caution, taking into consideration that patients with more severe complications or more fragile were probably less often considered for surgery, resulting in selection bias.

Read Full Article

Fibroelastoma, an Incidentaloma Disease? – Image Cases of Fibroelastomas as Incidental Findings in Four Patients, Four Different Valves

Abstract

Managing Patients with Infectious Endocarditis and Neurological Complication — The Big Dilemma that Persists Until these Days

Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre

Background:

Objective:

Methods:

Results:

Conclusions:

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)