Echocardiographic features of infective endocarditis in South Africa: A prospective cohort study.

BACKGROUND: Historically, infective endocarditis (IE) in South Africa (SA) was associated with the viridans group of streptococci affecting patients with underlying rheumatic heart disease (RHD). A changing IE bacteriological profile raises the question of whether the profile of underlying valvular abnormality has changed. OBJECTIVES: To investigate the prevalence of underlying structural valve abnormalities and their aetiologies associated with IE in SA, and describe the typical imaging findings. METHODS: The Tygerberg Endocarditis Cohort study prospectively enrolled patients with IE between November 2019 and April 2021. Patients underwent detailed transthoracic and transoesophageal echocardiography to assess their underlying cardiac and valvular structure. RESULTS: Among 71 patients included, a predisposing endocardial abnormality was detected in 49.3%, with RHD the most common single identifiable aetiology (16.9%). The in-hospital mortality rate was similar in patients with and without a predisposing endocardial abnormality (20% v. 16.7%; p=0.72), as was the rate of embolic events (20% v. 27.2%; p=0.58). Significantly more patients with a predisposing endocardial abnormality had an indication for surgery (94.3% v. 69.4%; p<0.01). The viridans group of streptococci was more prevalent in patients with a predisposing endocardial abnormality (25.7% v. 2.7%; p<0.01). Left-sided linear vegetation size >10 mm was associated with an increased risk of in-hospital mortality (24% v. 5%; p=0.05). CONCLUSION: We observed a marked decrease in the prevalence of RHD in this cohort of patients with IE. The viridans group of streptococci was an uncommon cause of IE in patients with no predisposing endocardial abnormality detected. The presence of a predisposing endocardial abnormality was not associated with an increased risk of in-hospital mortality or embolic events. Linear vegetation length >10 mm was associated with an increased risk of in-hospital mortality in patients with left-sided IE.

Early prediction of a significant patent ductus arteriosus in infants <32 weeks gestational age.

BACKGROUND: The optimal thresholds for identification of preterm infants at greatest risk for adverse sequelae related to patent ductus arteriosus have not been well delineated. Our aim was to determine hemodynamic parameters in the first 24 hours using continuous non-invasive vital and structural measurements to predict which infants required PDA treatment in our institution. METHODS: Retrospective secondary analysis of data from infants born 23 to 32 weeks gestational age with cardiac output and stroke volume via electrical cardiometry, cerebral tissue oximetry measurements, mean arterial blood pressure (BP), heart rate, and oxygen saturation and functional echocardiography results at 12 hours of life were recorded when available (93 percent of subjects). RESULTS: A total of 292 infants, of which 55 (26±2 weeks, 862±268 grams) were treated for PDA. Treated infants demonstrated increased left ventricular output (p < 0.001) and lower mean BP (p = 0.010). The optimal area under the receiver operating characteristic curve (AUC) for predicting PDA treatment in our all gestations cohort is a mean BP at 15 hours of life of <33 mm Hg (AUC = 0.854, p < 0.001, 95% CI 0.792, 0.916). For infants <28 weeks a mean BP at 13 hours of life of <33 mm Hg (AUC = 0.741, p < 0.050, 95% CI 0.642, 0.839). CONCLUSIONS: In our cohort increased left ventricular output and lower mean BP predicted a clinically significant PDA requiring treatment.

Sedative and echocardiographic effects of dexmedetomidine combined with butorphanol in healthy dogs.

OBJECTIVES: To evaluate the echocardiographic variables and sedation after two dosages of dexmedetomidine combined with butorphanol in healthy dogs. ANIMALS: Fourteen healthy dogs. METHODS: The dogs received dexmedetomidine 5 mcg/kg IM and butorphanol 0.4 mg/kg (low dose (LD), n = 6) or dexmedetomidine 10 mcg/kg IM and butorphanol 0.4 mg/kg (recommended dose (RD), n = 8). Sedation scoring, noninvasive blood pressure measurement, and echocardiography were performed before sedation at baseline, at 20 minutes (T20), and 60 minutes (T60) after drug administration. RESULTS: The median sedation scores were increased at both T20 and T60 in the RD group, and at T60 in the LD group, compared with baseline (p < 0.0001, p = 0.012). At T60, the RD dogs were more sedated than the LD dogs (p = 0.0093). The median cardiac output (CO) decreased at both T20 (63%) and T60 (65%) in the RD group and at T60 (42%) in the LD group, compared with baseline (p = 0.0011, p = 0.0055). The median heart rate (HR) was decreased at both T20 and T60 in the RD group and at T60 in the LD group, compared with baseline (p = 0.0009, p = 0.0001). In both RD and LD dogs, valvular regurgitation developed and was identified by color Doppler imaging. CONCLUSIONS: There were significant hemodynamic changes, mainly related to HR and indices of systolic function, following administration of dexmedetomidine in these healthy dogs. The changes also included decreases in systolic function and CO, as well as appearance of 'new' valvular regurgitation. Caution should be used when considering dexmedetomidine for sedation in dogs with, or being screened for, cardiovascular disease.

Characterization of adnexal masses: combination of color Doppler and conventional sonography compared with spectral Doppler analysis alone and conventional sonography alone.

OBJECTIVE: To evaluate the importance of color Doppler combined with conventional sonography in characterizing adnexal masses and to compare the results with those of spectral Doppler analysis alone and conventional sonography alone. MATERIALS AND METHODS: One hundred and fifteen women with 132 adnexal masses (98 benign, three borderline, and 31 malignant) were prospectively studied with conventional and Doppler sonography (transabdominal in all patients and transvaginal in 111). Three methods differentiated benign from borderline and malignant masses. In the first, conventional sonography was used. In the second, conventional sonography was combined with color Doppler. In this method, the presence of color flow in an echogenic portion classified as indeterminate or malignant by conventional sonography indicated malignancy; the absence of color flow in an echogenic portion classified as indeterminant or malignant at conventional sonography indicated benignancy; the presence or absence of color flow in a regular wall or septum indicated benignancy. The third method used spectral Doppler analysis. Malignancy was indicated by a resistive index (RI) less than or equal to 0.4, a pulsatility index (PI) less than or equal to 1, or a peak systolic velocity (PSV) greater than or equal to 15 cm/sec. RESULTS: Using conventional sonography alone, accuracy was 83%, sensitivity was 88%, and specificity was 82%. Using conventional sonography and color Doppler, accuracy was 95%, sensitivity was 88%, and specificity was 97%. Using spectral Doppler analysis and an RI less than or equal to 0.4, accuracy was 77%, sensitivity was 18%, and specificity was 98%. For a PI less than or equal to 1, accuracy was 68%, sensitivity was 71%, and specificity was 67%. For a PSV greater than or equal to 15 cm/sec, accuracy was 72%, sensitivity was 47%, and and specificity was 81%. CONCLUSION: Adding color Doppler to conventional sonography produced a specificity and positive predictive value higher than those of conventional sonography alone. Specificity increased from 82% to 97% (p < .001), and positive predictive value increased from 63% to 91%. RI, PI, and PSV were of limited value.

Epithelial tumors of the ovary: comparison of MR and CT findings.

Forty patients with 50 ovarian epithelial tumors of the ovary were retrospectively studied. They underwent computed tomography and magnetic resonance (MR) imaging within 1 week of surgery. MR examinations were performed with a superconducting magnet (0.5 T) and predominantly T1- and T2-weighted MR imaging. T1-weighted MR images were obtained in eight patients after contrast material was administered. Signal intensity of tumors was compared with that of urine, muscle, and fat. Morphologic features that were evaluated included size, vegetations, septations, wall thickness, fluid or solid components, and vascularity. On the basis of signal intensity and morphologic characteristics, MR imaging helped in the correct diagnosis of benign serous cystadenoma in 10 of 13 tumors, benign mucinous cystadenoma in seven of 10 tumors, and tumors of low malignant potential and malignant tumors in 23 of 27 tumors. Accuracy for overall characterization of benign versus malignant tumors was 86% with MR imaging and 92% with computed tomography. There was no difference in sensitivity (P = 1) or specificity (P = .5).