[Surgical treatment for endocarditis in Iceland 1997-2003].

INTRODUCTION: The aim of this study was to evaluate the outcomes of operations for endocarditis in Iceland, but such results have not been reported before. MATERIALS AND METHODS: Retrospective nation-wide study of pa--tients that underwent open-heart surgery for infective endocarditis at Landspitali University Hospital in 1997-2013. Variables were collected from hospital charts. Long-term survival was analysed using Kaplan- Meier methods. Mean follow-up time was 7.2 years. RESULTS: Out of 179 patients diagnosed with endocarditis, 38 (21%) -underwent open heart surgery. Two patients were excluded due to missing information leaving 36 patients for analysis. The number of operations steadily increased, or from 8 to 21 during the first and last 5-years of the study period (OR: 1.12, 95% CI: 1.05-1.21, p=0.002). The most common pathogen was S. aureus and 81% (29/36) of the patients had positive blood cultures. Three patients had history of previous cardiac surgery and five had history of intravenous drug abuse. The aortic valve was most often infected (72%), followed by the mitral valve (28%). The infected valve was replaced in 35 cases 14 with a mechanical prosthesis and 20 with a bioprosthesis. In addition two mitral valves were repaired. Postoperative complications included perioperative myocardial infarction (35%), respiratory failure (44%) and reoperation for bleeding (25%). Thirty-day mortality was 11% (4 patients) with 5- and 10-year survival of 59% and 49%, respectively. CONCLUSION: One out of five patients with endocarditis underwent surgery, most commonly aortic or mitral valve replacement. Outcomes were comparable to other studies. In comparison to elective valve replace-ment surgery the rate of post-operative complications and 30-day mortality were higher and long-term survival was less favorable. Key words: Endocarditis, surgical treatment, valve replacement, complications, outcome. Correspondence: Arnar Geirsson, arnargeirsson@yahoo.com.

[Pulmonary alveolar proteinosis - a case report]. / Próteinútfellingar í lungnablöðrum meðhöndlaðar með lungnaskoli.

Pulmonary alveolar proteinosis (PAP) is a rare lung disease of unknown origin, where an amorphous lipoprotein material accumulates in the alveoli of the lungs. We describe a young male with a four month history of progressive dyspnea, low grade fever, hypoxemia and weight loss. Chest X-ray showed diffuse interstitial and alveolar infiltrates in both lungs. The diagnosis of PAP was confirmed with trans-bronchial lung biopsy. Because of a deteriorating clinical course a whole lung lavage was performed. Under general anesthesia, both lungs were lavaged with warm saline in two different sessions with good results. Two years later the patient is almost free of symptoms and lung function has markedly improved.