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BackgroundIdentifying subgroups of asymptomatic patients with aortic stenosis (AS) who may benefit from early intervention is a critical challenge due to the risk of sudden death and irreversible myocardial dysfunction without preceding symptoms. In this study, we analyzed the determinants and prognostic value of Galectin-3 in a large cohort of patients with AS.MethodsWe included patients with at least mild degenerative AS enrolled in 2 ongoing prospective clinical studies, COFRASA and GENERAC, aiming at assessing the determinants of AS occurrence and progression.ResultsBetween November 2006 and July 2013, 583 patients were prospectively enrolled. Severe AS was diagnosed in 312 (56%) patients among whom 220 (38%) were symptomatic. Age (p

Background Infective endocarditis after Bentall operation is rare and its diagnosis may be difficult. Purpose We described clinical presentation, management, outcomes and the use of new imaging added in the 2015 European Society of Cardiology guidelines (18F-fluorodeoxyglucose positron emission tomography/computed tomography, radiolabelled white blood cell single-photon emission computed tomography/computed tomography and Cardiac computed tomography) in patient with infective endocarditis after Bentall. Methods We retrospectively identified all patients with definite infective endocarditis after Bentall hospitalized in a tertiary care centre in Paris, France between 2005 and 2016. Results Twenty patients were identified (Median age 61 years, 95% male). Most cases occurred more than twelve months after the Bentall procedure (65%). Ten patients had complications (mainly stroke). The most common pathogen was Staphylococcus aureus (45%). Lesions using echocardiography were observed at the aortic valve and/or tube level in 18 patients. The most frequent lesion was a peri-prosthetic abscess and peritubular thickening/collection. At least one new imaging testing was performed in 12 patients (60%). The diagnosis of definite infective endocarditis relied on the modified Duke criteria in 17 patients and on new imaging in 3 patients. Disagreement between the different new imaging tests was relatively common. Eighteen patients (90%) underwent surgery and 4 died during their hospital stay (20%). Conclusion Infective endocarditis after Bentall mainly occurred late after surgery and was due to S. aureus. New imaging was a useful adjunct in patients with non-definite infective endocarditis and should be integrated into clinical judgment. Mortality was high and surgery was a cornerstone of the management.

From November 2007 to April 2011 we performed 170 minimally invasive mitral valve repairs. Among them one of us did perform this modified “respect but not resect” strategy for 70 patients. No resection was needed except for one endocarditis. Perioperative mortality was 0% . None SAM occur during or after procedure. During perioperative period no regurgitation or grade 1 regurgitation were found in 44 patients. Only one had a grade 2 regurgitation at discharge. During follow-up none redo surgery was needed for repair dysfunction , one patient scheduled for endocarditis.

Purpose The incremental diagnostic value of 18-fluorodeoxyglucose positron emission tomography (FDG-PET) and radiolabeled leukocyte scintigraphy (LS) has already been reported in infective endocarditis (IE) patients. The aim of this study was to compare the respective performances of FDG-PET and LS for the diagnosis of prosthetic valve (PVE)-IE in 39 patients. Methods FDG-PET and LS were performed in 39 consecutive patients admitted for a clinical suspicion of PVE and inconclusive echocardiography who underwent both FDG-PET and LS. FDG-PET and LS were analysed separately and retrospectively by experienced physicians blinded to the results of the other imaging technique and to patient’s outcome. Final Duke-Li IE classification was performed after a 3-month follow-up period. Results Out of the 39 patients, 15 patients were classified after a 3-month follow-up period as definite IE, 3 as possible IE and 21 as excluded IE. Average time interval between FDG-PET and LS acquisitions was 7±7 days. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 93%, 71%, 70%, 94% and 81% for FDG-PET and 60%, 100%, 100%, 78% and 83% for LS, respectively. Discrepancies between the results of FDG-PET and LS occurred in 12 patients (31%). In patients with definite IE, 5 were identified with true positive FDG-PET but false negative LS. Out of these 5 patients, 3 presented non-pyogenic microorganism IE (Coxiella or Candida). In patients with excluded endocarditis, 6 patients were identified with true negative LS but false positive FDG-PET. These 6 patients had been imaged in the first two months following the last cardiac surgery. Conclusions FDG-PET offers a high sensitivity for the detection of active infection in patients with a suspicion of PVE. LS offers a higher specificity than FDG-PET for IE diagnosis and should be considered in case of inconclusive FDG-PET findings or in the first two months after cardiac surgery.

Objective In patients with a suspicion of prosthetic valve endocarditis (PVE), detection of perivalvular infection can be difficult based only on echocardiography, but has an important impact in guiding surgical indications. The aim of this retrospective study was to test the interest of leukocyte scintigraphy (LS) for detection of perivalvular infection in patients with suspicion of non-complicated PVE. Methods LS was performed in 42 patients admitted for suspicion of PVE. Results of LS were classified as positive, with either intense or mild accumulation of radiolabeled leukocytes in the cardiac area, or negative. Macroscopical aspects and bacteriology were obtained from patients who underwent cardiac surgery (n=10). Clinical outcome was collected in patients treated medically (n=32). Results Among patients with an intense signal with LS who underwent surgery (n=6), 5 had an abscess confirmed during intervention, and 1, post-operatively. Patients with an intense accumulation of radiolabeled leukocytes with scintigraphy and treated medically (n=3) had a poor outcome: death (n=1); prosthetic valve dehiscence (n=1); recurrent endocarditis (n=1). Among patients with a mild activity with LS (n=5), one patient developed a large prosthetic valve dehiscence during follow-up. The 4 remaining patients were treated medically and did not present any recurrent endocarditis after a median follow-up of 14 months. No abscess was detected in patients with negative LS who underwent surgery (n=4). Among patients with negative LS treated medically (n=24), none presented recurrent endocarditis after a mean follow-up of 15±16 months. In total, LS helped to identify perivalvular infection or abscesses in 12 out of 42 patients (29%). Conclusion This retrospective study suggests that LS is useful for identification of perivalvular infection and could help in guiding surgical indications in patients with suspicion of PVE.

Background We recently reported an atypical possible prosthetic valve infective endocarditis (PVIE) occurring on a stentless Cryolife O’Brien ® aortic bioprosthesis without inflammatory markers, negative blood cultures but anatomic damage suggestive of IE and aimed to look for other cases. Methods We reviewed all cases of possible or definite aortic PVIE according to the modified Duke criteria hospitalized in our institution between January 2002 and March 2008. Results 60 patients with possible or definite aortic PVIE were admitted during this period (26 mechanical prosthesis, 11 stented bioprosthesis and 23 stentless Cryo-Life O’Brien ® bioprosthesis). Compared to mechanical or stented prosthesis, patients with stentless valve presented less frequently with fever (39% vs. 77% and 91%, p=0.003), tended to present more frequently in congestive heart failure (54% vs. 23% and 36%, p=0.10), less frequently with positive blood cultures (44% vs. 65% and 82%, p=0.08) and with lower CRP levels (69±70 mg/L vs. 144±106 mg/L and 145±123 mg/L, p=0.02). Patients with stentless valve also presented less frequently with vegetations (22% vs. 58% and 63%, p=0.01) but more frequently with valve dehiscence (68% vs. 23% and 22%, p=0.006) and severe aortic regurgitation (65% vs. 23% and 36%, p=0.01). 40 patients were operated on within 30 days, more frequently in the stentless group (83% vs. 61% and 45% respectively, p=0.07). Compared to the previously reported incidence of stentless PVIE at our institution (1.5%), we observed a striking increase incidence after 2004 (>7%). Conclusion We report a frequent and atypical clinical and microbiological presentation of possible PVIE occurring on stentless bioprosthesis and a striking increased incidence after 2004 which corresponds to changes in the manufacturing process. Clinicians should be aware of this atypical clinical presentation. The stentless Cryo-Life O’Brien ® bioprosthesis is not anymore implanted at our institution.