Infective endocarditis in elderly and very elderly patients.
- 作者列表："Menchi-Elanzi M","Ramos-Rincón JM","Merino-Lucas E","Reus-Bañuls S","Torrús-Tendero D","Clíment-Paya V","Boix V","Portilla-Sogorb J
AIMS:To compare the clinical and epidemiological characteristics and the evolution of infective endocarditis in adults aged under 65 years, 65-79 years, and 80 years or older. METHODS:An observational retrospective cohort study in patients with infective endocarditis was performed in a public hospital in Spain from January 2013 to December 2017. RESULTS:Seventy-two patients were treated: 26 (36.1%) were under 65 years old, 28 (38.9%) were 65-79 years old, and 18 (25%) were aged 80 or older. Prosthetic valve endocarditis was less common in patients aged 65-79 years (3.6%) than in younger (23.1%; p = 0.047) or older (38.9%; p = 0.004) patients. In contrast, degenerative heart disease was more prevalent in the 65-79 year age group [64.3% compared to 15.4% (p < 0.001) in the youngest group, and 33.3% (p = 0.04) in the oldest]. Surgical interventions were similar in patients aged 65-79 (50%) and under 65 years (42.3%), but less common in people over 80 years (16.7%; p = 0.022). CONCLUSIONS:The characteristics of infective endocarditis are different in patients aged 65-79 years and in those over 80 years.
目的: 比较65岁以下、65 ~ 79岁和80岁以上成人感染性心内膜炎的临床和流行病学特点及演变。 方法: 从2013年1月到2017年12月，在西班牙的一家公立医院对感染性心内膜炎患者进行了一项观察性回顾性队列研究。 结果: 72例患者接受了治疗: 26例 (36.1%) 65岁以下，28例 (38.9%) 65-79岁，18例 (25%) 80岁以上。人工瓣膜心内膜炎在65-79岁患者 (3.6%) 中较年轻患者 (23.1%; P = 0.047) 或老年患者 (38.9%; P = 0.004) 较少见。相比之下，退行性心脏病在65-79岁年龄组中发病率更高 [64.3%，而最年轻组为15.4% (p <0.001)，最年长组为33.3% (p = 0.04)]。65-79岁 (50%) 和65岁以下 (42.3%) 患者的手术干预相似，但80岁以上人群的手术干预较少 (16.7%; P = 0.022)。 结论: 65 ~ 79岁和80岁以上患者感染性心内膜炎的特点不同。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.