RESUMO
OBJECTIVES: Infective endocarditis is a life-threatening complication of congenital heart disease (CHD), but there are few studies concerning the contemporary risk profile, preceding invasive procedures and outcomes in this patient population. The aim of this study was to investigate the epidemiology of infective endocarditis (IE) in patients with CHD. METHODS: Cases of IE in children and adults with CHD were prospectively recorded as part of the UK National Institute for Cardiovascular Outcomes Research (NICOR) National Congenital Heart Disease Audit. Patients were entered into the database between April 2008 and March 2016. RESULTS: Eight hundred episodes of IE were recorded in 736 patients with CHD. Sixty-five patients (9%) were infants (aged <1 year), 235 (32%) were children (aged 1-15 years), and 436 (59%) were adults (aged >15 years). The most common diagnoses were Tetralogy of Fallot (nâ¯=â¯150, 22.8%), ventricular septal defect (nâ¯=â¯129, 19.6%) and bicuspid aortic valve (nâ¯=â¯70, 10.7%). Dental procedures preceded 67 of 635 episodes (11%) of IE, and non-dental invasive procedures preceded 177 of 644 episodes (27.4%). The most common causative organisms were streptococci, accounting for 40% of cases. Overall in-hospital mortality was 6.7%. On multivariable analysis, adverse factors associated with in-hospital mortality were staphylococcal infection and presence of an underlying atrioventricular septal defect. CONCLUSIONS: Infective endocarditis in patients with CHD is an ongoing clinical challenge. In contemporary practice in tertiary congenital centers, 1 of 15 patients do not survive to hospital discharge. Streptococci remain the most common causative organism, and antecedent dental or medical procedures were undertaken in a significant minority in the 3 months before diagnosis. The presence of an atrioventricular septal defect or staphylococcal infection is associated with significantly increased risk of early mortality.
Assuntos
Endocardite/epidemiologia , Cardiopatias Congênitas/complicações , Medição de Risco/métodos , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Endocardite/etiologia , Endocardite/microbiologia , Feminino , Seguimentos , Cardiopatias Congênitas/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Incidência , Lactente , Masculino , Vigilância da População/métodos , Prevalência , Estudos Prospectivos , Fatores de Risco , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia , Adulto JovemRESUMO
In the 16 years since the first pioneering procedure, transcatheter aortic valve implantation (TAVI) has come of age and become a routine strategy for aortic valve replacement, increasingly performed under conscious sedation via transfemoral access. Simplification of the procedure, accumulation of clinical experience, and improvements in valve design and delivery systems have led to a dramatic reduction in complication rates. These advances have allowed transition to lower risk populations, and outcome data from the PARTNER 2A and SURTAVI trials have established a clear evidence base for use in intermediate risk patients. Ongoing studies with an expanding portfolio of devices seem destined to expand indications for TAVI towards lower risk, younger and asymptomatic populations. In this article, we outline recent advances, new devices and current guidelines informing the use of TAVI, and describe remaining uncertainties that need to be addressed.
Assuntos
Estenose da Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter , Previsões , Humanos , Complicações Pós-Operatórias/epidemiologia , Guias de Prática Clínica como Assunto , Medição de Risco , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/tendênciasAssuntos
Endocardite Bacteriana , Endocardite , Valvas Cardíacas , Humanos , Incidência , Instrumentos CirúrgicosAssuntos
Dor Abdominal/etiologia , Oclusão Vascular Mesentérica/complicações , Veias Mesentéricas , Trombose Venosa/complicações , Dor Abdominal/diagnóstico por imagem , Adulto , Fator V/genética , Família , Predisposição Genética para Doença/genética , Heterozigoto , Humanos , Masculino , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Trombose Venosa/diagnóstico , Trombose Venosa/diagnóstico por imagemRESUMO
Recreational open fires are an important and preventable cause of burn. In contrast to adults, who often sustain flame burns, children are at higher risk of thermal contact burns caused by hot embers many hours after the fire was first lit. Cases of thermal contact injury in children due to recreational fires were reviewed and the potential of a small charcoal fire to cause burns over a prolonged period was tested. Between 1993 and 2007, 67 children were admitted for treatment, with a median age of 1.6 years. Total burn surface area ranged from 0.5% to 19.5% (median 4%) with burns most commonly affecting the hands and feet. The average length of stay was 7 days and a total of 81 surgical procedures were carried out. Injury was most commonly sustained after falling into (40%), or accidentally crawling or walking on (30%), the remnants of an unextinguished fire. Small charcoal fires retain sufficient heat to cause injury at least 16h after lighting. Strategies for prevention of these injuries are outlined.