Left-sided native valve Staphylococcus aureus endocarditis

Despite improved diagnostic tools and expanded treatment options, left-sided native valve endocarditis caused by Staphylococcus aureus infection remains a serious and destructive disease. The high morbidity and mortality, however, can be reduced by early recognition, correct diagnosis, and appropriate treatment. In the following article, we discuss the clinical presentation, diagnostic workup and treatment of infective endocarditis, thereby reviewing the current guidelines. Blood cultures and echocardiography are the cornerstones of diagnosis in identifying infective endocarditis but are no substitute for clinical judgement. The modified Duke criteria may facilitate the diagnostic process, but clinical evaluation remains crucial.

Recurrent acute pulmonary oedema after aortic and mitral valve surgery due to trachea malacia and obstructive sleep apnoea syndrome

In this report we describe a patient with recurrent episodes of acute pulmonary oedema after aortic and mitral valve surgery. The first episode of pulmonary oedema was caused by mitral valve dysfunction. The second episode of pulmonary oedema was not clearly associated with a mitral valve problem, but reoperation was performed in the absence of another explanation. After the third episode of acute pulmonary oedema occurred, the diagnosis of obstructive sleep apnoea syndrome (OSAS) was considered and confirmed. After starting treatment with continuous positive airway pressure (CPAP) during his sleep the patient had no further episodes of acute respiratory failure. Our case demonstrates that acute pulmonary oedema after cardiothoracic surgery can be caused or at least be precipitated by OSAS and should be suspected in patients with unexplained episodes of (recurrent) pulmonary oedema. (Neth Heart J 2008;16:310-2.).

[Massive haemolysis: a rare manifestation of sepsis due to Clostridium perfringens]

A 59-year-old man was admitted to the hospital to be operated on for carcinoma of the pancreas. During the operation, it turned out that resection ofthe tumour was not possible. Therefore, a double bypass was created for palliation: hepaticojejunostomy and duodenojejunostomy. The postoperative course was complicated by a fulminant sepsis accompanied by massive intravascular haemolysis. This is a rare and often fatal complication of a Clostridium perfringens sepsis. The patient was given antibiotics and multiple blood transfusions, but his haemoglobin remained low and despite the administration of large amounts of fluid, high doses ofinotropic agents and corticosteroids, it was not possible to achieve an adequate circulation. The patient died within 40 hours after admission to Intensive Care. Severe intravascular haemolysis with spherocytes in the blood smear must be interpreted as an important indication of a C. perfringens-sepsis.

Transmyocardial laser revascularisation and other treatment modalities for angina pectoris

Ischaemic heart disease is one of the leading causes of morbidity and mortality in the western world. This paper provides an overview of the different treatments for one of the most common manifestations of ischaemic heart disease: angina pectoris. Besides the currently available conventional methods, several alternative treatments are described, with a special focus on transmyocardial laser revascularisation.

New developments in the management of heart failure: a review of the literature in 2002

In 2002, several studies were directed at new developments in the management of heart failure. In the COPERNICUS study, the previously reported benefits of the beta-adrenoreceptor blocker carvedilol regarding morbidity and mortality in patients with mild-to-moderate heart failure were also found in patients with severe heart failure. Carvedilol not only improves survival but when given in addition to conventional therapy, ameliorates the severity of heart failure and reduces the risk of clinical deterioration, hospitalisation and other serious adverse events. The diagnostic value of B-type natriuretic peptide (BNP) in patients with congestive heart failure has been a topic of study for the past five years. Many questions still need to be answered but the results of a study by Maisel et al. show that BNP is not only of diagnostic value but is also important for prognosis and evaluation of therapy. A substudy of the Val-HeFT study focussed on the effects of the angiotensin receptor blocker valsartan on BPN and noradrenaline levels. Valsartan significantly reduced the combined endpoint of mortality and morbidity and improved clinical signs and symptoms in patients with heart failure, if added to prescribed therapy. However, in a post-hoc observation an adverse effect on mortality and morbidity was seen in the subgroup receiving valsartan, an ACE inhibitor and a beta-blocker, which raised concern about the potential safety of this specific combination. And finally, interesting work by Abraham et al. on cardiac resynchronisation through atrial-synchronised biventricular pacing clearly shows that this therapy can produce a significant clinical improvement in patients with moderate-to-severe congestive heart failure and intraventricular conduction delay.

Acute haemodynamic consequences and simultaneous echocardiographic images of severe systolic anterior motion of the anterior mitral valve leaflet following aortic valve replacement

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Intermittent jamming of a mitral valve prosthesis

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