0275: Diagnosis, complications and management of infective endocarditis: experience of Tunisian military hospital

BackgroundInfective endocarditis (IE) is lethal if not aggressively treated with antibiotics alone or in combination with surgery. The epidemiology of this condition has substantially changed over the past four decades, especially in industrialized countries. Once a disease that predominantly affected young adults with previously well-identified valve disease – mostly chronic rheumatic heart disease – IE nowadays tends to affect older patients and new at-risk groups, including intravenous-drug users, patients with intracardiac devices and degenerative valvular heart disease…ObjectivesWe aimed to evaluate demographic data, underlying cardiac abnormalities, clinical profile, microbiological features, treatments and complications of IE.MethodsA retrospective study of all cases with the diagnosis of definite endocarditis according to Duke Criteria admitted to The Tunisian Military Hospital between January 2001 and December 2007.ResultsThe study included 53 patients (32 males and 21 females; mean age 44.5±16.5 years). Infective endocarditis developed on a native valve in 48 patients (90%), a mechanical prosthetic valve in 5 patients (5%). Rheumatic heart disease in 26 cases (49%) was the most common preexisting valvular abnormality in native valve endocarditis. The mitral valve was the most commonly affected valve 23 (43.4%). Fever occurred in 50 (94%) of the cases. Trans-thoracic and/or trans-esophageal echocardiography showed vegetation and/or abcess in 33 patients (62.2%). Streptococci in 17 cases (32%) and Staphylococci in 13 cases (24%) were the most common causative agents. Twenty-six patients (49%) underwent surgical treatment. Cardiac complications occurred in 13% of cases, vascular complications in 18% of cases, cerebrovascular accidents in 15% of cases and septic metastatic complications in 15% of cases.ConclusionsIE usually occurred on rheumatic heart disease. Its diagnosis is based on hemocultures and echocardiography. There are deficiencies in applying prophylaxis, which is a justification for the improvement of patient management through education

Multimodality imaging assessment of a caseous calcification of the mitral valve annulus

Caseous calcification of the mitral annulus (CCMA) is a rare echocardiographic finding. It is commonly misdiagnosed as an abscess, tumor or infective vegetation on the mitral valve. Since it is a benign process, differentiating it from malignant intra-cardiac mass is primordial to avoid unnecessary surgery. Various imaging modalities can be complimentary for definitive diagnosis. We present a case of CCMA in a 71-year-old female patient. Her medical history revealed hypertension, diabetes mellitus, hyperlipidaemia and coronary artery disease. She was referred to our department for coronary catheterization because of angina symptoms upon minimal exertion. The lesion was detected during echocardiography and was defined as a mass of heterogeneous content with calcification points, located at the posterior side of the mitral valve annulus. Restricted motion of the posterior leaflet and the mass effect caused only minimal mitral regurgitation. To establish the correct diagnosis, we performed the full spectrum of noninvasive cardiac imaging modalities. Transesophageal echocardiography identified well-organized, composite lesion with regular edges, markedly calcified margins and more echolucent central portion. A computed tomography (CT) was performed, showing a hyperdense mass with hypodense center and a calcified peripheral rim located at the posterior mitral ring. Cardiac magnetic resonance imaging (MRI) showed that the mass was hypointense with respect to the myocardium in the T1 and T2-weighted sequences and only presented late-phase enhancement in the surrounding capsule. Based on the CT and MRI findings, the diagnosis of CCMA was established. The patient was managed conservatively