Management of infective endocarditis and multidisciplinary approach.

INTRODUCTION: The morbi-mortality related to infective endocarditis (IE) remains high as the epidemiology has changed over the last years: ageing of patients, comorbidity and healthcare-associated infections. To optimize IE management, a weekly endocarditis multidisciplinary meeting (EMM) was set up at our facility. We present the activity report of the EMM. PATIENTS AND METHODS: All patients hospitalized for IE who were presented at the weekly EMM between January 2013 and June 2017 were prospectively included. The main objective was to assess the impact of the EMM on the management of community-acquired IE and healthcare-associated IE by analyzing in-hospital case fatality. RESULTS: Of the 1139 cases reported during the EMM for suspicion of IE, 493 (86% were definite cases) were selected for the study: 262 patients had community-acquired IE and 231 had healthcare-associated IE; 43% of IEs involved a valvular prosthesis. Following the EMM, infections were documented in 92% of cases: staphylococci in 45% of healthcare-associated IEs and streptococci in 44% of community-acquired IE cases. A septic embolism was diagnosed in 57% of cases. Finally, 49% of patients underwent surgery. The in-hospital case fatality was 12% with no significant difference between community-acquired IEs and healthcare-associated IEs. Case fatality was also significantly higher in elderly patients, in the absence of surgical treatment, initial heart failure, or Staphylococcus aureus IE. CONCLUSION: The weekly EMM allows our facility to follow the European Society of Cardiology guidelines and to adapt the management of each patient to improve IE prognosis.

Infective endocarditis caused by Streptococcus tigurinus-like organisms.

Streptococcus species are important causes of infective endocarditis but species identification remains challenging. We report two cases of infective endocarditis due to Streptococcus tigurinus-like organisms, which were first identified by 16S ribosomal RNA gene sequence analysis and subsequently confirmed using phylogeny based on the analysis of the shetA gene encoding exfoliative toxin.

[Caseous calcification of the mitral annulus, variable and revealing clinical picture, and the contribution of cardiac tomodensitometry to the diagnosis: report of two cases]. / Nécrose caséeuse de l'anneau mitral, polymorphisme des tableaux cliniques révélateurs et apport de la tomodensitométrie cardiaque au diagnostic : à propos de deux cas.

Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification and a common echocardiographic finding. CCMA discovery is mostly incidental, considered as benign tumor and may be unrelated to patient symptoms. Multimodality imaging may have an additional value for the diagnosis of CCMA. We report the cases of two CCMA revealed by acute pulmonary oedema and stroke, respectively. The aims of this presentation are: to illustrate the variety of cardiac symptoms that led to the diagnosis of CCMA; and to highlight the usefulness of thoracic multisliced computed tomography for the diagnosis of CCMA.