ABSTRACT
Trans-catheter aortic valve implantation (TAVI) has recently emerged as a less invasive alternative to surgical aortic valve replacement (SAVR) in high risk patients. Although several procedures have been performed worldwide, infective endocarditis (IE) has been reported to be a rare TAVI complication, nevertheless if IE occurs it represents a life-threatening condition and treatment is challenging. TAVI-IE are thus normally treated conservatively by targeted antibiotic therapy with a high reported mortality (40%). Surgical explant represent the definitive strategy but, the intervention is at a high risk (risk of complication 87%, with an in hospital mortality of about 47%). In the present paper, we report the case of a 71-year-old patient affected by an early endocarditis after TAVI (TAVI-IE) treated at our Institution by surgical explant. The case highlights a paradox: if TAVI procedures are indicated over traditional surgical valve replacement in treatment of high surgical risk patients, what should be the best management when TAVI-IE occurs in these same population of patients?
Subject(s)
Endocarditis/microbiology , Postoperative Complications/microbiology , Prosthesis-Related Infections/microbiology , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aortic Valve Stenosis/surgery , Device Removal/methods , Endocarditis/surgery , Humans , Male , Photography , Postoperative Complications/surgery , Prosthesis-Related Infections/surgery , Reoperation , Streptococcal Infections/surgery , Streptococcus mitisABSTRACT
Tracheobronchomegaly is a rare condition characterised by marked dilation of the trachea and the main bronchi. The clinical presentation of this disease is nonspecific and the diagnosis is based on the radiological features, especially computed tomography of chest. Pulmonary function tests are often abnormal showing airflow limitation with increased residual volume. The authors report a rare case of a 31-year-old man presenting tracheobronchomegaly is normal pulmonary function test.
Subject(s)
Image Processing, Computer-Assisted , Lung Volume Measurements , Pulmonary Diffusing Capacity/physiology , Tomography, Spiral Computed , Tracheobronchomegaly/diagnostic imaging , Adult , Drainage, Postural , Humans , Male , Plethysmography , Reference Values , Tracheobronchomegaly/physiopathology , Tracheobronchomegaly/therapyABSTRACT
Our study investigated alpha 1 antitrypsin deficiency (AATD) diagnosis in a family originated from central Tunisia and showing a familial history of asthma. Biochemical and genetic diagnosis for AATD was performed according to current diagnostic standards. AAT level quantification in affected individuals showed plasma AAT levels consistent with intermediate AATD (ranged from 0.91 to 1.04 g/L). The molecular analysis was assessed using the genotyping of the most prevalent PI*S and PI*Z SERPINA1 mutations and the sequencing of AAT coding exons for rare AATD variants detection. No PI*S or PI*Z deficient variants were seen in this family. Sequencing results showed the inheritance of the deficient rare variant PI*M(wurzburg) (P369S) at the heterozygous state in the mother and two affected siblings. However, AATD status remains unexplained in the third affected case, with no mutations detected in the AAT coding exons.
