Pilar Tornos Mas

2015 ESC Guidelines for the management of infective endocarditis

3D : three-dimensional AIDS : acquired immune deficiency syndrome b.i.d. : bis in die (twice daily) BCNIE : blood culture-negative infective endocarditis CDRIE : cardiac device-related infective endocarditis CHD : congenital heart disease CIED : cardiac implantable electronic device

Linee guida ESC 2015 per il trattamento dell'endocardite infettiva: Task Force per il Trattamento dell'Endocardite Infettiva della Società Europea di Cardiologia (ESC): Con il patrocinio dell'Associazione Europea di Chirurgia Cardiotoracica (EACTS) e dell'Associazione Europea di Medicina Nucleare (EANM)

Authors/Task Force Members: Gilbert Habib* (Chairperson) (France), Patrizio Lancellotti* (co-Chairperson) (Belgium), Manuel J. Antunes (Portugal), Maria Grazia Bongiorni (Italy), Jean-Paul Casalta (France), Francesco Del Zotti (Italy), Raluca Dulgheru (Belgium), Gebrine El Khoury (Belgium), Paola Anna Erba (Italy), Bernard Iung (France), Jose M. Miro (Spain), Barbara J. Mulder (The Netherlands), Edyta Plonska-Gosciniak (Poland), Susanna Price (UK), Jolien Roos-Hesselink (The Netherlands), Ulrika Snygg-Martin (Sweden), Franck Thuny (France), Pilar Tornos Mas (Spain), Isidre Vilacosta (Spain), and Jose Luis Zamorano (Spain)Autori/Membri della Task Force Gilbert Habib (Chairperson) (Francia), Patrizio Lancellotti (co-Chairperson) (Belgio), Manuel J. Antunes (Portogallo), Maria Grazia Bongiorni (Italia), Jean-Paul Casalta (Francia), Francesco Del Zotti (Italia), Raluca Dulgheru (Belgio), Gebrine El Khoury (Belgio), Paola Anna Erbaa (Italia), Bernard Iung (Francia), Jose M. Mirob (Spagna), Barbara J. Mulder (Olanda), Edyta Plonska-Gosciniak (Polonia), Susanna Price (UK), Jolien Roos-Hesselink (Olanda), Ulrika Snygg-Martin (Svezia), Franck Thuny (Francia), Pilar Tornos Mas (Spagna), Isidre Vilacosta (Spagna), Jose Luis Zamorano (Spagna)

Secondary tricuspid valve regurgitation: a forgotten entity

### Learning objectives The tricuspid valve was virtually ignored for a long time in the past. However, the incidence of tricuspid insufficiency associated with left valvular disease is quite significant, ranging from 8% to 35% of cases.1 ,2 This is most common in conjunction with mitral valve disease but association with aortic valve pathology is not uncommon. It is most frequently related to rheumatic valve disease and much rarer in association with degenerative mitral valve disease. In most cases, the tricuspid regurgitation (TR) is so-called ‘functional’, corresponding to dilatation of the annulus, as a consequence of RV dilatation secondary to pulmonary hypertension. In 15–20% of cases, however, the injury can be organic, generally of rheumatic origin, but for the purposes of this work we will restrict our analysis to secondary (terminology now preferred over functional) TR. Originally, it was thought that in most patients with secondary TR, surgical treatment of the mitral valve disease would correct the problems of the right side and, hence, a conservative (no touch) approach to the tricuspid valve was recommended.3 ,4 More recently, however, it has become evident that in a significant number of cases secondary TR does not regress after appropriate correction of the left-side valvulopathy. Thus, the indications for surgery of the TR have moved towards a progressively more interventional attitude. Today, it is evident that we must intervene on the tricuspid valve in cases of obviously severe tricuspid insufficiency and in cases where perioperative detection of a more significant TR than expected is made, especially when triggered by increasing load conditions.5 ,6 In this work, we intend to review the current …

Epidemiology of Infective Endocarditis in Spain in the Last 20 Years

Infective endocarditis is an uncommon disease, with an estimated incidence of 3.1 to 3.7 episodes per 100 000 inhabitants/year. The incidence is highest in elderly people. The microorganisms most frequently isolated in infective endocarditis are staphylococci and streptococci. In the last few decades, the spectrum of heart diseases predisposing to infective endocarditis has changed, since degenerative heart disease is the most common valve disease, and there are an increasing number of infective endocarditis patients without previously known valve disease. In addition, up to one-third of infective endocarditis patients become infected through contact with the health system. These patients are more frail, which leads to higher in-hospital mortality. As a result of substantial epidemiological changes, few cases of infective endocarditis can be prevented by antibiotic prophylaxis. Despite advances in medical and surgical treatment, in-hospital mortality among infective endocarditis patients is high. Nevertheless, there is room for improvement in reducing the rate of nosocomial bacteremia, the prompt diagnosis of infective endocarditis in at-risk patients, and the early identification of patients with a highest risk of complications, as well as in the creation of multidisciplinary teams for the management of this disease.

Oclusión crónica total del tronco común de la coronaria izquierda

La oclusion total cronica del tronco comun es unhallazgo angiografico poco frecuente. Tras revisarlas coronariografias realizadas en nuestro centroentre 1986 y 1995, encontramos una prevalenciadel 0,04%. Estos pacientes presentaron una clinicainespecifica no diferenciable de otros grados de enfermedadcoronaria, existiendo en todos ellos unaarteria coronaria derecha dominante con ampliacirculacion colateral hacia la coronaria izquierda.La funcion ventricular estaba conservada en el 50%de los casos. Probablemente, en estos infrecuentescasos, la mejor alternativa terapeutica sea la cirugiade revascularizacion.

2017 ESC/EACTS Guidelines for the Management of Valvular Heart Disease

Authors/Task Force Members: Volkmar Falk (EACTS Chairperson) (Germany), Helmut Baumgartner (ESC Chairperson) (Germany), Jeroen J. Bax (The Netherlands), Michele De Bonis (Italy), Christian Hamm (Germany), Per Johan Holm (Sweden), Bernard Iung (France), Patrizio Lancellotti (Belgium), Emmanuel Lansac (France), Daniel Rodriguez Mu~ noz (Spain), Raphael Rosenhek (Austria), Johan Sjögren (Sweden), Pilar Tornos Mas (Spain), Alec Vahanian (France), Thomas Walther (Germany), Olaf Wendler (UK), Stephan Windecker (Switzerland), Jose Luis Zamorano (Spain)

The Scope of Cardiological Competence in New Clinical Settings. Spanish Society of Cardiology Consensus Document

Cardiology is the medical discipline or specialty responsible for the prevention, diagnosis, and treatment of cardiovascular disease. As this is the major cause of morbidity and mortality in Spain and the European Union,1 cardiology professionals have, with respect to other medical specialists, an additional moral authority and responsibility derived from the relevance for society of an excellent performance in combating cardiovascular disease. Hence the importance of keeping up with the rapid transitions that are currently taking place at the social, administrative, educational, health care, and professional levels, transitions that necessarily generate novel contexts for the practice of cardiology and for its professionals. At the end of 2005, the Spanish Society of Cardiology (SSC), by virtue of its leadership role in combating cardiovascular disease, decided to undertake a project, applying a synthetic approach to the process matrix, involving the professionals in cardiology and in other medical specialties, the health care administrations, the pharmaceutical industry, and biotechnology companies, the institutions, the patients and the general population; these processes will ultimately play a role in the development of the field of cardiology, in the work of The Scope of Cardiological Competence in New Clinical Settings

РЕКОМЕНДАЦИИ ESC ПО ВЕДЕНИЮ БОЛЬНЫХ С ИНФЕКЦИОННЫМ ЭНДОКАРДИТОМ 2015

The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC) Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM)

Recurrent prosthetic mitral valve infective endocarditis and perivalvular abscess: first description by PET/CT angiography

A 69-year-old womanwith a history of rheumatic valvulopathy requiring mechanical prosthetic valve substitution 11 years previously was admitted to our service because of fever. Physical exploration was unremarkable. Blood cultures were positive for cloxacillin-resistant Staphylococcus epidermidis. The echocardiogram showed a large mitral vegetation without signs of perivalvular abscess or prosthetic dysfunction. The patient received a 6-week regimen of daptomicin, gentamicin and rifampicin, with immediate negativization of the blood cultures and a good evolution. However, blood cultures became positive for the same microorganism 2 weeks after the end of the treatment. Repeat transoesophageal echocardiography showed only a small residual vibrating mass. F-FDG PET/CT angiography with myocardial suppression showed a periprosthetic mitral abscess that was able to explain the recurrent endocarditis. The oblique coronal view (a) shows a large residual nodular calcification of the posterior mitral ring. Short-axis, two-chamber and four-chamber fused images in the mitral plane (b–d) show intense focal FDG uptake (SUVmax 13) in the same location [1, 2]. The patient underwent surgery during which a periprosthetic mitral abscess at the inferior ring was completely resected. The antibiotic regimen was repeated and the blood cultures remained negative after 3 months of follow-up.

¿Son iguales todas las prótesis? ¿Prótesis diferentes para indicaciones diferentes?

Transcatheter aortic valve implantation has become an accepted treatment option for patients with severe symptomatic aortic stenosis who are at a high surgical risk. In particular, randomized trials have shown that the technique is associated with lower mortality in inoperable patients than medical treatment and is noninferior to conventional surgery in patients at a high surgical risk. From its inception, transcatheter aortic valve implantation has shown great potential and, consequently, considerable effort has been devoted to designing new devices that can provide better outcomes and that can expand indications to ever more complex anatomies and to patients with multiple comorbidities. This review describes developments in the design of novel transcatheter prostheses and discusses recent findings with the application of these new-generation prostheses.