Infective endocarditis is a rare disease, with an incidence of two to six episodes per 100,000 habitants/year. Incidence is higher in elderly people; besides, this group is often affected by many comorbidities. There is a clear and observable change in the spectrum of heart diseases predisposing to infective endocarditis in the last decades. Up to one-third of the patients acquire the disease on a health-care-associated environment. Despite advances in health-care logistics, infective endocarditis remains a big concern especially in low-income countries, where the main cause of infection is rheumatic fever. In-hospital mortality persists relatively high despite development in medical and surgical treatment. Patients with infective endocarditis need rapid response and prompt diagnosis from a multidisciplinary group including cardiologists, surgeons, infectologists, and radiologists.
Part of the book: Contemporary Challenges in Endocarditis
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but life‐threatening complication of acute pulmonary embolism (PE). This entity is the consequence of a persistent obstruction of the pulmonary arteries and progressive vascular remodeling. Some patients with CTEPH do not have a history of classic pulmonary embolism symptoms. The diagnostic process to detect CTEPH should include ventilation‐perfusion scintigraphy, which has a high sensitive and negative predictive value (nearly 100%) and CT angiography demonstrating typical features of CTEPH (occlusion of pulmonary arteries, mosaic perfusion or intraluminal bands or webs). Patients suspected of having CTEPH must be referred to an experienced center in order to complete the diagnostic workup (right‐heart catheterization and pulmonary angiography) and determine the best treatment. Pulmonary endarterectomy (PEA) remains the treatment of choice for CTEPH and is associated with excellent long‐term results and a highly curative rate. Patients with inoperable CTEPH are given medical and interventional modalities.
Part of the book: Embolic Diseases
Before the antibiotic era and cardiac surgery, infective endocarditis (IE) was a predominantly fatal disease. In-hospital mortality persists relatively high despite development in medical and surgical treatment. Adequate timing and surgical management of the infected valve help prevent substantially early and late mortality. The surgical approach of mitral valve endocarditis should be based on extension of the disease and annular involvement. When the valve and annulus are severely affected, the best option is to perform a complete excision and mitral valve replacement (MVR). Only if the disease is limited to the valvular tissue, mitral valve repair is the preferred surgical option.
Part of the book: Advanced Concepts in Endocarditis
Primary spontaneous pneumothorax (PSP) is a common disease in medical practice that affects young healthy people with a significant recurrence rate. PSP is the presence of air in the pleural space not caused by injury or medical intervention. Some risk factors include male gender, age, and smoking. Classic clinical presentation starts with acute-onset chest pain and shortness of breath. Physical examination can be normal in small pneumothoraces, but in larger pneumothoraces, breath sounds and tactile fremitus are typically decreased or absent, and percussion is hyperresonant. Chest X-ray can help confirm the diagnosis. Evacuation of air from the pleural cavity and prevention of future recurrences are the primary goals of treatment and depend on the patient’s presentation. Initial deciding factors to direct the management are first-time or recurrent spontaneous pneumothorax and size of the pneumothorax. Treatment may include conventional chest tube drainage, video-assisted thoracoscopic surgery (VATS), or open surgery.
Part of the book: Pneumothorax