Surgical treatment of multi-valve heart disease of infective endocarditis

Peculiarities of diagnosis and results of surgical treatment of multi-valve heart disease in infective endocarditis. Analyze data and clinical results operated 156 patients with infective endocarditis, of which 85 were men (56.5%), and women -71 (45.5%). Age Our patients ranged from 12 to 68 (mean 32.76 ± 1.6) years. Diagnosis was based on the classiϐication and criteria Durack D.T. The patients were divided into 2 groups: group 1, 89 (57.4%) patients who underwent a complex developed by the authors of antibiotic therapy, treatment and preventive measures. 2-group 67 (42.6%) patients who underwent the traditional surgical treatment scheme. The diagnosis used: electrocardiography (ECG), X-rays from Skopje, transthoracic echocardiography (TTEHOKG) - all patients, transesophageal echocardiography (TEHOKG) - at 40.5%; coronaroventriculography (CVG) and angiocardiography (ACG) - at 12.65%; blood culture study in 38.6% of patients, with light gistrology electron microscopy (LEM) - in 47.5% of patients.Intraoperative treatment - preventive measures (TPM) were as follows; mechanical and chemical sanitation of the infected area of the heart; valve implantation antibakteriyalnymi properties; hyperthermic perfusion; anti microbial therapy, including anti-fungal agents. Application of the above measures could reduce mortality in the study group and 5.1% in the control group - 9.3%. In dynamics, declined to 3.9% in the last Godi mortality in the study group.

Predictors of Maternal and Neonatal Complications in Patients With Severe Valve Heart Disease During Pregnancy

Background: The severe valve disease especially stenosis is a contraindication to conception according to WHO. This situation is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine the predictors of maternal cardiac, obstetric and neonatal complications. Methods: This is an observationnal study of all pregnant women with severe valvulopathy, delivered between 2010 and 2017. Results: We included 60 pregnancies in 54 women. Cardiac complications occurred in 37 patients (61%). In multivariate analysis, the predictors for these complications were parity (OR = 2.41, p = 0.023), revelation of valvulopathy by pregnancy (OR = 6.34, p = 0.025), severe mitral stenosis (OR = 6.84, p = 0.035) and systolic pulmonary arterial pressure (OR = 1.08, p = 0.01). Obstetrical complications were noted in 19 women (31.8%). The predictive factors for these complications were primiparity (OR = 5.22, p = 0.032), multiple valve disease (OR = 5.26, p = 0.028), systolic pulmonary arterial pressure (OR = 1.04, p = 0.04) and treatment with vitamin K antagonist (OR = 8.71, p = 0.04). Neonatal complications were noted in 39% of new-borns. The predictive factors for these complications were the occurrence of obstetric complications (OR = 15.48, p = 0.001) and the revelation of valvulopathy by pregnancy (OR = 6.95, p = 0.017). Conclusions: The revelation of valve disease by pregnancy is predictor of not only cardiac complication but also neonatal complications, thus valve disease screening during pre-conceptional counselling is crucial.

Double-Valve Heart Disease and Glomerulonephritis Consequent to Abiotrophia defectiva Endocarditis

Abiotrophia defectiva, a nutritionally deficient streptococcus, is a rare cause of infective endocarditis. It has been associated with hemophagocytic syndrome. We present the first case of A. defectiva infective endocarditis that led to antineutrophil cytoplasmic antibody-associated glomerulonephritis. The patient was a 55-year-old man whose endocarditis affected the mitral and aortic valves. His course was complicated by atrial fibrillation, stroke, and glomerulonephritis. He was successfully treated with antibiotics and dual valve replacement.

Reliability and construct validity of the Instrument to Measure the Impact of Valve Heart Disease on the Patient's Daily Life

ABSTRACT Objective: evaluate the practicality, acceptability and the floor and ceiling effects, estimate the reliability and verify the convergent construct's validity with the instrument called the Heart Valve Disease Impact on daily life (IDCV) of the valve disease in patients with mitral and or aortic heart valve disease. Method: data was obtained from 86 heart valve disease patients through 3 phases: a face to face interview for a socio-demographic and clinic characterization and then other two done through phone calls of the interviewed patients for application of the instrument (test and repeat test). Results: as for the practicality and acceptability, the instrument was applied with an average time of 9,9 minutes and with 110% of responses, respectively. Ceiling and floor effects observed for all domains, especially floor effect. Reliability was tested using the test - repeating pattern to give evidence of temporal stability of the measurement. Significant negative correlations with moderate to strong magnitude were found between the score of the generic question about the impact of the disease and the scores of IDCV, which points to the validity of the instrument convergent construct. Conclusion: the instrument to measure the impact of valve heart disease on the patient's daily life showed evidence of reliability and validity when applied to patients with heart valve disease.