Clinical - microbiological characterization and risk factors of mortality in infective endocarditis from a tertiary care academic hospital in Southern India.

AIMS: To dissect the clinical-microbiological profile of Infective endocarditis (IE) population and to determine the risk factors for IE related mortality. METHODS: A cohort study was conducted using relevant data from clinical records of patients (≥12years) with definite/possible IE from December 2007 to December 2013 and was analyzed using appropriate statistical tests. RESULTS: In the cohort of 139 IE patients, mean age was 47.9±15.8years, with male preponderance (68.3%). Rheumatic heart disease was the commonest (30.9%) underlying cardiac lesion followed by mitral valve prolapse with mitral regurgitation (23.7%), degenerative valvular disease (23%), congenital heart disease (15.8%) and prosthetic valves (3.6%). Vegetations were detected in 94.2% cases. Blood cultures were positive in 69.8% cases, commonest organism isolated was α - hemolytic streptococci (30.9%) followed by Enterococcus (12.9%) and methicillin sensitive Staphylococcus aureus (10.8%). Complications observed were congestive cardiac failure (31.2%), acute kidney injury (25.9%), stroke (21.6%), septic shock (16.5%), embolic phenomenon non-stroke (8.6%), atrial fibrillation (5%) and ring abscess (2.9%). Mortality rate was 17.3%. Congestive cardiac failure, increase in the peak leucocyte count and stroke were the independent predictors of mortality. CONCLUSIONS: This study reiterates the persistent dominance of rheumatic heart disease in the population studied and α - hemolytic Streptococci as the commonest responsible microorganism.

Coronary steal or large collateral? Three cases of graft failure in sequential and composite grafts.

Coronary bypass grafting using conduits with multiple distal anastomoses continues to demand scrutiny. While on one hand these techniques allow the surgeon to avoid or minimise aortic manipulation, the unique flow and pressure characteristics lead to complex forms of graft failure if the anatomy of the target vascular bed is not carefully taken into consideration. We report three cases of graft failure in patients with coronary bypass grafting performed using multiple distal anastomoses, and percutaneous revascularisation in one patient.

Successful patent ductus arteriosus device closure in a patient with massive pulmonary embolism.

Patent ductus arteriosus, an essential vasculature structure during fetal life that becomes abnormal after 3 months of age, may be silent. However, the incidence of silent patent ductus arteriosus is as high as 1 in 500 patients. Existence of patent ductus arteriosus leads to left-to-right shunt. The development of pulmonary embolism in left-to-right shunt is rare. We present a case of a 33-year-old male patient who was incidentally diagnosed to have large patent ductus arteriosus along with the left-to-right shunt while being treated for pulmonary embolism. The patient was treated electively with device closure of patent ductus arteriosus. .