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Background: To assess early and late mortality in patients with isolated acute tricuspid valve infective endocarditis (TVIE) using data from a multicenter registry.Methods: From 1983 to 2018, isolated acute TVIE was surgically treated in 157 (3.8%) patients [mean age 47 +/- 16 years (range 15-86 years), 25% females]. Of these, 142 (90%) had native tricuspid regurgitation, 7 (5%) native tricuspid valve (TV) steno-regurgitation, and 8 (5%) prosthetic TVIE. Intravenous drug use (IVDU) was recorded in 38% of patients, infection involved cardiac implantable electronic device leads in 21%, and vascular catheters for dialysis in 1%; in the remaining cases, the cause was unknown. The primary endpoint was in-hospital outcome, long-term freedom from recurrence and overall survival.Results: Overall, 77 (49%) patients underwent TV repair, 72 (46%) TV replacement, and 8 (5%) prosthetic TV replacement. Early mortality was 11% (n = 17). Expected early mortality according to EndoSCORE was 12%, with age (odds ratio 1.06) and redo (odds ratio 6.64) as risk factors. Late deaths occurred in 31 patients and TVIE recurrences in 4. Survival rates at 10, 20, and 25 years were 66%, 60%, and 44%, respectively. Risk factors were age [hazard ratio (HR) 1.06], mycotic TVIE (HR 4.2), IVDU (HR 4.90), infected prosthesis replacement (HR 4.4), and presence of cardiac implantable electronic device leads (HR 3.0). No significant difference was found in valve repair vs. replacement and in IVDUs vs. non-IVDUs.Conclusions: Patients with isolated acute TVIE undergoing surgical treatment show acceptable early and late outcomes. TVIE recurrence was low, and repair of the affected valve does not seem to confer any advantage either at early or long term up to 25 years. (C) 2019 Elsevier B.V. All rights reserved.

Background Mobilization of endothelial progenitor cells (EPCs) into circulation from bone marrow in patients with acute myocardial infarction has strong scientific evidence; less is known about EPC mobilization in patients with stable coronary artery disease (CAD). The aim of this study was to investigate the association of stable ischemic heart disease with EPC levels in tissue and blood. Methods Fifty-five consecutive patients admitted to a single treatment center for valve or coronary artery bypass grafting (CABG) surgeries were included in the study. Blood samples were collected in the morning before surgery and analyzed by flow-cytometry to determine peripheral EPC levels (EPC/ml). Tissue EPC (CD34+VEGFR2+) levels were assessed on a right atrial appendage segment. Results Mean age was 76±5years, 48% were men, and 53% had CAD The number of CD34+ VEGFR2+ cells in the tissue of patients with CAD was significantly higher ( p Conclusion Patients with stable CAD had higher EPC density values (EPC/mm2) and were more likely to have lower EPC blood levels when compare with normal controls.

Endothelialprogenitorcells(EPCs)aremobilizedfrombonemarrowinto peripheral blood, contributing to the revascularization of ischemicareas, to endothelial repair and to the physiological maintenance ofvascularization. EPC mobilization and homing have been primarilylinked to ischemia and inflammation presence [1]. EPCs are directlycorrelated with endothelial function and inversely correlated withcardiovascular risk factors and atherosclerosis progression [2].EPClevelshavealsobeencorrelatedtoprognosisevaluationincardiovascu-lar disease [3].Regarding EPC correlation with coronary artery disease (CAD)presence and severity, an inverse relationship with CAD severity, inde-pendent of traditional risk factors, was demonstrated by EPC colonycounting [4],whileahighnumberofEPCsassociatedwithCADandcorre-latedwithstenosisseveritywereshownby flowcytometry [5].Recentlyanew protocol, adapted from the standardized ISHAGE protocol for hema-topoieticstemcells,hasbeendevelopedforEPClevelevaluationtoenablecomparison of clinical and laboratory data [6].While thepresence of circulatingEPCshasbeenwidely evaluated indifferent diseases, few studies tried to evaluate the presence of EPCs inhuman vital myocardium.TheaimofourstudywastoinvestigateEPClevelsbothinperipheralbloodand inmyocardium in thesame patients atthesame time, evalu-atingthecorrelationwith CADpresence. In bothsampleswequantifiedCD34

We present a patient with a left atrial myxoma in whom the intraoperative use of transesophageal cross-sectional echocardiography proved helpful in selecting the most appropriate surgical approach, thus allowing expeditious and complete excision of the tumor. This technique, which permits continuous monitoring of cardiac function throughout open heart procedures, appears particularly valuable in patients with intracardiac masses.

We report a patient in whom fracture of the guidewire occurred while attempting a percutaneous transluminal coronary angioplasty, requiring emergency surgical intervention. This case indicates that, despite the fact that complications of percutaneous transluminal coronary angioplasty are decreasing, the availability of open heart facilities remains mandatory during this procedure.

A consecutive series of 459 mitral valves, which had been surgically excised over a 6-year period, were evaluated by means of macroscopic and histologic study. Of the valves, 379 specimens showed evidence of rheumatic disease (82.6%), 51 were floppy (11.1%), while 29 (6.3%) belonged to a heterogeneous group. The last included cases of ischemic disease (2.4%), infective endocarditis (2.4%), congenital dysplasia (0.9%), rheumatoid arthritis (0.4%), and primary dystrophic calcification (0.2%). Eighty-seven patients had had pure mitral incompetence. Among these, floppiness of the leaflets was the major indication for valvar replacement (58.6%), followed by rheumatic disease (12.7%), ischaemic incompetence (12.7%), and infective endocarditis (11.5%). Particular attention was paid to the clinical-pathological profile of patients with floppy valves as the cause of severe incompetence. This confirmed the prevalence of male patients and the frequent incidence of complications, particularly rupture of tendinous cords (54.9%). A striking difference was also found between the mean age of those patients with and without Marfan's disease (15.3 vs. 53.9 years, P less than 0.001). Although mitral incompetence in the presence of a floppy valve could simply be due to deformity of the leaflets, elongation of the cords and dilatation of the atrioventricular junction, in over half of the cases the precipitating event leading to surgery was rupture of tendinous cords.