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Objective: This observational study was aimed to analyze the clinical characteristics of infective endocarditis (IE) in patients with hypertrophic cardiomyopathy (HCM). Methods: A total of 668 patients with IE, and 7 427 patients with HCM were treated in Fuwai Hospital from August 2006 to December 2018. Among them, 14 patients were diagnosed with HCM and IE. The clinical characteristics of these patients including clinical manifestations, pathogen distribution, echocardiography features, in-hospital treatment and outcomes were analyzed retrospectively. Results: The proportion of HCM patients with IE was 0.19%,with the estimated incidence of 0.15/1 000 person-years in HCM patients. Of the 14 patients, 11 patients were male. The most common clinical manifestations were fever and heart murmur, and the main complications were heart failure (12/14) and bacterial embolism (8/14). There were 8 cases (8/14) with positive blood culture, and all causative bacteria were gram positive coccus, in which 5/8 were Streptococcus . The median interventricular septum thickness was (21.2±2.7) mm, and left ventricular outflow obstruction was severe based on echocardiography (Echo) examination. The Echo showed that vegetation was found in all 14 patients and most of the vegetation attached at the anterior leaflet of mitral valve (12/14). The proportions of patients with circulatory embolism (8/14) and valve lesions (12/14) were relatively high. Most cases (10/14) were cured, especially those underwent cardiac surgery (8 cases). The rest 4 cases died with 2 in hospital and 2 after auto-discharge. Conclusions: HCM patients complicated with IE are rare. Septic embolization and valve lesions are common in these patients. IE patients with HCM might have a poor prognosis compared to those without HCM and should receive cardiac surgery as early as possible.

Objective: To analyze the effect of maternal age on pregnancy outcome in patients with structural heart disease. Methods: Totally 986 patients diagnosed with structural heart disease who had their delivery at Renji Hospital from January 1st, 2003 to December 31st, 2016 were divided into 5 groups according to maternal age. Sixteen (1.6%) were in age group <20 years, 204 (20.7%) were in age group 20-24 years, 461 (46.8%) were in age group 25-29 years, 222 (22.5%) was in age group 30-34 years and 83 (8.4%) was in age group ≥35 years. The incidence of cardiac, obstetric and fetal complications among these groups were analyzed. Results: Among the 986 patients with structural heart disease, 82 (8.3%) experienced adverse cardiac events (some patients had more than 1 complication) , including infective endocarditis (0.4%, 4/986) , malignant arrhythmia (3.3%, 33/986) , heart failure (5.3%, 52/986) , cardiac death (0.9%, 9/986) . The incidence of cardiac complications were respectively 12.5%,11.3%,4.8%,10.4% and 14.5% in each age group, with statistically significant differences when compared with one another ( P= 0.004) . There was no statistically significant difference in the incidence of obstetric complications ( P> 0.05) . The incidence of fetal complications in each group showed statistically significant differences ( P= 0.001) ; which was 25.0%,30.4%,24.1%,29.3% and 47.0% respectively. Conclusions: Age group 25- 29 years presented the lowest risk of cardiac complications and is potentially the optimal age for pregnancy and delivery. Age group <20 or ≥35 years is at higher risk for cardiac complications. The highest rate of fetal complications is in age group ≥35 years.

Objective: To analyze the clinical characteristics of infective endocarditis (IE) in culture-positive patients,so as to provide the evidences for reasonable diagnosis and treatment of IE., Methods: We performed a retrospective study of 157 culture-positive IE cases,which were diagnosed according to modified Duke criteria for IE from Jan. 2008 to Aug. 2015., Results: The average age of 157 cases of IE was 40.85 years. One hundred and one patients (64.3%) had various underlying cardiac diseases,including congenital cardiovascular diseases in 44 cases and rheumatic heart diseases in 15 cases. The main clinical manifestations were anemia (147 cases,93.6%),fever(137 cases,87.3%) and heart murmur (120 cases,76.4%). Vegetation was found in 12 cases (7.6%) with transesophageal echocardiography (TEE) but not with transthoracic echocardiography (TTE) . Culture results showed the most common causative microorganisms were Streptococci (76 cases,48.4%),with Viridans streptococci dominated in 70 cases,and Staphylococci (33 cases,21.0%) ( Staphylococcus aureus dominated in 18 cases). All patients were treated with antimicrobial agents. Eighty-five patients (54.1%) received surgical intervention,of which 72 cases received valve replacement. Twenty-seven patients were cured,88 patients were markedly improved,38 patients discontinued treatment,and 4 patients died. The therapeutic efficacy of operation group was better., Conclusion: The clinical characteristics of IE included: the age of onset increased,congenital heart disease was the most underlying disease,and Viridians streptococci was the most popular causative microorganism. Surgical therapy can effectively improve the outcomes of IE patients., (CopyrightCopyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Objective: To analyze the clinical manifestations, epidemiological features, pathogens, treatment and outcomes of 112 patients with infectious endocarditis., Methods: The clinical data were reviewed for all the patients with the diagnosis of infectious endocarditis in Nanfang Hospital over the period from 2002 to 2012., Results: The average age of disease onset was 46∓17.1 years among these cases. Seventy patients (62.5%) had underlying cardiac conditions, including, in the order of frequency, rheumatic heart disease, congenital cardiovascular anomalies, and senile valve degeneration. Clinically the patients presented with fever, anemia, congestive heart failure, and embolism events, etc. Echocardiography found endocardial neoplasms in 105 cases, and the mitral valve was often involved. Blood culture yielded positive results in 61 cases, and the most common causative bacteria were Streptococcus (20.5%), Staphylococcus (19.6%) and Enterococcus (5.4%). Surgical intervention was performed in 78 cases. Ninety-one patients were cured or improved after comprehensive treatment, and 10 discontinued treatment for financial reasons; 11 died of cardiac failure (8 cases), pulmonary embolism (2 cases) and central nervous system events (1 case)., Conclusion: Infectious endocarditis shows a significant change in the clinical profiles and its mortality remains high despite improved diagnostic and therapeutic procedures.

Objective: To analyze the clinical characteristics of 18 patients with isolated right sided infective endocarditis (RSIE) who hospitalized in our department between August 2005 and February 2009., Methods: The epidemiological and clinical data of 18 non-drug addicts with RSIE were retrospectively analyzed., Results: The incidence of RSIE accounted for 7.23% of all IE patients hospitalized in our department during the same period. Predisposing conditions were as follows: congenital heart disease (76.5%, 14/18), post operative procedures (3/18) and high dose glucocorticoids use (1/18). Fever (100%) was the most common clinical manifestation. Septic pulmonary embolism was the most prevalent complication (5/18). Staphylococci aureus (4/7) were the most common causative patho organisms, while the most common etiological organisms of left-sided and both-sided IE were Streptococci Viridans. Transthoracic echocardiography evidenced 17 cases of vegetations including 59.1% (13/22) tricuspid vegetations. There was no in-hospital death and the mean hospitalization duration was (22.0 +/- 18.9) days., Conclusions: Congenital heart diseases, but not intravenous drug abuse, were the most prevalent predisposing factors for RSIE in this cohort. Staphylococci aureus were the most common causative organisms.

In order to evaluate whether there were changes of the clinical features of Staphylococcus (Staph.) aureus endocarditis in recent years, the data of 21 cases of Staph. aureus endocarditis diagnosed from 1977 to 1994 were analyzed and compared with those of 11 cases of Staph. aureus endocarditis from 1957 to 1977. The results showed the following changes in recent years. The incidence of Staph. aureus endocarditis cases has been increasing. Cases of right-sided endocarditis increased in the recent two decades and this increase was related to intravenous drug abuse and increased use of vascular intervention. Right-sided endocarditis was different from left-sided endocarditis in their risk factors, underlying heart diseases, clinical manifestations and prognosis. The clinical manifestations of ventricular-wall endocarditis were atypical and it could be definitely diagnosed only with echocardiogram. Complications of Staph. aureus endocarditis became more common and serious, in recent decades but hospital mortality decreased markedly due to effective antibiotic management. The authors believe that sound knowledge of Staph. aureus endocarditis is essential for the proper diagnosis and treatment of Staph. aureus endocarditis.