[Infectious endocarditis]. / Endocardite infectieuse.

The incidence of infective endocarditis has not decreased over the last years. Infective endocarditis remains severe: the mortality rate during the initial hospital stay is 15%, and a surgical intervention is needed in 25% of the cases. Stricter application of prophylaxis guidelines and better diagnostic and therapeutic management should decrease the frequency and severity of infective endocarditis.

[Primary prevention of atherosclerosis]. / Prévention primaire de l'athérosclérose.

Primary prevention consists of acts that decrease the level of risk factors in order to avoid the occurrence of atherosclerosis or to limit its consequences. Even incomplete control of risk factors leads to substantial decrease in the overall risk. Such results should encourage individuals and physicians to continue their efforts. First, the absolute risk for an individual should be evaluated on a risk scale. Then, the various factors to be targeted are smoking, hypertension, plasma lipid anomalies, lack of balanced diet, overweight, sedentary life style and diabetes. Compliance to recommended changes in life style varies greatly, which probably explains why the observed benefit is less than expected. Prevention should be an integral part of daily practice, and the motivation of both physicians and individuals must be constantly supported.

[Tricuspid valve replacement: long-term clinical and echocardiographic follow-up]. / Le remplacement valvulaire tricuspidien: suivi clinique et échographique à long terme.

Long term results of tricuspid valve replacement, were evaluated by echocardiographic and clinical means retrospectively on 55 patients hospitalized at the Montreal Heart Institute between 1969 and 1993. Twenty seven percent were male and 73% female. Taking into account differences in means of myocardial protection the whole population was divided in 2 groups. Group 1: 19 patients from 1969 to 1980. Group 2: 36 patients - from 1981 to 1994. Forty seven patients (85%) received a bioprosthesis and 8 (15%) a mechanical valve. Forty one (74%) had another surgical procedure and 60% (33 patients) were re-operations. Mortality at 30 days is 23% (13 patients) -15% group 1 and 27% group 2. Twenty six patients (72%) of group 2 were re-operations compared with 7 (36%) for group 1 (p = 0.026). Risk factors of operative mortality were: high systolic pulmonary pressure (0.051), bypass time (0.012) and abnormal ejection fraction (0.025). Mean time of follow up is 113.8 months completed at 95%. Six patients were re-operated; 4 for failure of bioprosthesis 11.5 years (mean) after initial surgery. Forty three percent of patients presented with an amelioration of NYHA class. 26% in class I and 50% in class II. Mean gradient across the tricuspid valve was 4.1 +/- 1 mm Hg. Twenty two over 42 patients (50%) died during follow up: 75 months after surgery.