Native aortic endocarditis due to an unusual pathogen: Actinotignum schaalii.

We report a case of aortic native valve endocarditis due to Actinotignum schaalii in an 89-year-old man with prostatism history but no signs of urinary infection. Actinotignum schaalii was isolated not only from positive blood culture but also from cardiac valve culture using mass spectrometry and 16S rDNA sequencing. Actinotignum schaalii is recognized as commensal of genitourinary tract, but it was underdiagnosed. The advances in bacterial identification such as MALDI-TOF MS probably explain the increasing described cases of infections due to A. schaalii these last years.

[Pulmonary revalvulation and rhythmologenic risks in patients with repaired tetralogy of Fallot]. / Revalvulation pulmonaire et risque rythmique chez les patients opérés d'une tétralogie de Fallot.

Tetralogy of Fallot is a frequent congenital heart disease that has been repaired since the mid-1950s. The follow-up after repair is good despite a persistent risk of sudden death. The risk factors in long-term follow-up are advanced age at repair, hemodynamic status of the right ventricle, QRS duration≥180ms, left ventricular dysfunction, and existence of sustained or not ventricular tachycardia. In the presence of significant pulmonary regurgitation, it is necessary to perform revalvulation either by classic surgery or cardiac catheterization. To correct the risk of ventricular arrhythmia, some have proposed radiofrequency ablation of critical isthmus, or cryo-application during surgery. However, the use of implantable cardioverter defibrillator is another therapeutic option that is more and more employed as secondary or primary prevention in patients at risk of sudden death.

Percutaneous left atrial appendage closure improves left atrial mechanical function through Frank-Starling mechanism.

BACKGROUND: Modifications in left atrial (LA) flow velocities after left atrial appendage (LAA) exclusion have been shown in animal and ex vivo models. In a substudy of PROTECT AF (Percutaneous Closure of the Left Atrial Appendage Versus Warfarin Therapy for Prevention of Stroke in Patients With Atrial Fibrillation), an objective improvement in quality of life was observed after LAA closure. OBJECTIVE: The purpose of this study was to investigate the impact of LAA closure on LA transport function. METHODS: Comprehensive transthoracic echocardiography evaluation (2-dimensional [2D]/3-dimensional [3D], 2D speckle tracking) was prospectively performed before and after LAA closure (at discharge and 45 days after procedure) in 33 patients. RESULTS: LAA closure was associated with a significant improvement in LA reservoir function at discharge and 45 days after the procedure with (1) increased maximum LA volume index, (2) increased 2D-LA reservoir volume and expansion index, and (3) increased 2D speckle tracking-derived peak atrial longitudinal strain (PALS) (27.9 ± 14 and 26 ± 12.6 vs 21.7 ± 10.7%, P <.0001). LAA closure was also associated with a significant improvement in LA contractile function with (1) increased LA ejection fraction and (2) increased speckle tracking-derived peak atrial contraction strain (PACS) in sinus rhythm patients (19.1 ± 6.8 and 18.1 ± 5.4 vs 14.4 ± 6.4%, P = .0006). Conversely, the slope of the relation between PACS and PALS remained unchanged (0.5 ± 0.27 and 0.53 ± 0.3 vs 0.5 ± 0.25, P = .99), thus arguing for an improvement in LA contractile function secondary to a Frank-Starling effect rather than a modification in its intrinsic contractility. CONCLUSION: LAA closure was associated with an improvement in LA mechanical function. These changes appeared to be related to a modification in loading conditions, that is, a Frank-Starling effect.