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Right-sided infective endocarditis (RSIE) accounts for 5–10% of all cases of infective endocarditis and is predominantly encountered among injecting drug users (IDUs). RSIE diagnosis requires a high index of suspicion as respiratory symptoms predominate. Prognosis of isolated RSIE is favourable, and most cases (70–80%) resolve following antibiotic administration. Surgical intervention is indicated in patients with persistent infection that does not respond to antibiotic therapy, recurrent pulmonary emboli, intractable heart failure and if the size of a vegetation increases or persists at >1 cm. Techniques can be divided into ‘prosthetic’ (valve replacement or prosthetic annular implantation) or ‘non-prosthetic’ ones (Kay's or De Vega's annuloplasty, bicuspidalization or valvectomy). In IDUs who run a high risk of complications, vegetectomy and valve repair, avoiding artificial material should be considered as the first line of surgical management as is associated with better late survival. [ABSTRACT FROM AUTHOR]

Summary: Vasa vasorum (VV) are microscopic vases that perfuse the vessel''s wall; arteries and veins. Many recent researches support the opinion that VV have a significant role in aortic pathology. The VV, or ‘the vessels of the vessels’, form a network of microvessels that lie in the adventitia and penetrate the outer media of the host vessel wall. Although the importance of the VV in providing nutritional support is not well known, obstruction of blood flow through these vessels has been implicated in the pathogenesis of many cardiovascular diseases such as aortic intramural hematoma, aortic aneurysm, and acute or chronic aortic dissection. Although the proliferation of VV due to atherogenic stimuli is controversial, experimental and clinical studies strongly suggest the potential of VV in vascular proliferative disorders. It seems that the rupture of VV is implicated in intramural hematoma, which can develop in acute aortic dissection. In this review article, we would like to stress the anatomy and mainly the pathophysiology, and the implication of VV in the acute and chronic aortic pathologies. [Copyright &y& Elsevier]

Summary: Giant left atrium (GLA) is a condition defined when the left atrial diameter exceeds 65mm. GLA is commonly associated with mitral valve regurgitation due to excess intracavitary pressure resulting in strain and dilation of the left atrial chamber. The mechanism of lone GLA remains unknown but is possibly related to inherent weakening of the atrial wall tissue. The enlarged left atrium leads to expansion of left atrial volume, which in turn can place pressure on the main bronchus, lung, and left ventricle with corresponding cardiopulmonary embarrassment. Because GLA can increase the risk of sudden death, its existence merits careful evaluation and surgical intervention when needed. Careful review of the literature reveals that the presence of GLA in the context of severe mitral valve regurgitation with or without atrial fibrillation is the most common indication for surgical intervention. Indications for intervening on lone GLA are rare except when compressive symptoms manifest. Partial resection of inferior and or superior left atrial wall is the most common surgical technique. With the evolution of atrial fibrillation surgery, atrial size matters and is determinant of long term performance following successful ablation. Surgical management of GLA achieves good clinical outcome with respect to cardiopulmonary performance including restoration of sinus rhythm among patients suffering from atrial fibrillation. Surgeons should be aware of current modalities for atrial volume reduction when indicated to retain the function and structure of the left atrium. [Copyright &y& Elsevier]

A response from the authors of the article "Right-sided infective endocarditis: surgical management" in the 2012 issue is presented.