Third Re-Do Surgery in a Young Woman with Massive Early Double-Valve Prosthesis and Thromboembolic Stroke

Valvular heart disease affects more that 100 million people worldwide. Valvular replacement remains the only definite treatment for most of the patients with severe disease. Careful medical management and periodic followup of valve function is mandatory in order to prevent or diagnose prosthesis-related complications. We present a case of extensive mitral and aortic valve thrombosis and possible recurrent endocarditis in a 44-year-old woman non-adherent to anticoagulation therapy, presented with stroke. She also had a history of two mitral and aortic valvular heart replacement surgeries. Comprehensive and repeated imaging was used to evaluate and monitor the patient progression and outcome. Failure of adequate anticoagulation therapy to improve prosthesis function during hospitalization required third re-do surgery for mitral and aortic valve replacement with mechanical prosthesis.

Challenges associated with delivering education to patients after heart surgery.

The purpose of this report is to provide a detailed description of the challenges that arose throughout the implementation of an individualized patient education intervention delivered to patients during their home recovery following heart surgery. The intervention was delivered at two points in time by telephone to patients following heart bypass and/or valvular replacement. The individualized patient education intervention was found to be effective in reducing the rate and number of complications developed during the first three months following hospital discharge. However, throughout the implementation of this intervention, specific challenges arose that included: onset of symptoms that interfered with intervention delivery, patient’s request for information beyond the scope of the teaching interaction, and the need to provide continued support to the therapist. These challenges were addressed throughout the course of the study and the strategies are currently being implemented into the planned knowledge translation activities associated with this intervention.

Challenges associated with delivering education to patients after heart surgery.

The purpose of this report is to provide a detailed description of the challenges that arose throughout the implementation of an individualized patient education intervention delivered to patients during their home recovery following heart surgery. The intervention was delivered at two points in time by telephone to patients following heart bypass and/or valvular replacement. The individualized patient education intervention was found to be effective in reducing the rate and number of complications developed during the first three months following hospital discharge. However, throughout the implementation of this intervention, specific challenges arose that included: onset of symptoms that interfered with intervention delivery, patient’s request for information beyond the scope of the teaching interaction, and the need to provide continued support to the therapist. These challenges were addressed throughout the course of the study and the strategies are currently being implemented into the planned knowledge translation activities associated with this intervention.

Valvular lesions and Epilepsy, Khartoum, Sudan 2018

Introduction: Epilepsy is either; idiopathic when there is no underlying cause or secondary if there is an underlying cause of egg brain tumors, stroke. There is a strong in conjunction between epilepsy and valvular lesions. Objective: To study the relationship between valvular lesions and Epilepsy among Sudanese epileptic patients. Methodology: Almost 50 Sudanese patients with valvular lesions were included in the study during Jane 2018 to Jane 2019. Result: Out of 50 patients (48%) males while females (52%). Almost 40% of the patients were found to have generalized tonic colonic epilepsy, while 60% have focal epilepsy. Pure MS was the common valvular lesion observed. 14% of the patients had atrial fibrillation, especially with mitral stenosis .4% of the patients underwent valvotomy. Abnormal EEG was observed in 64% of the patients. Abnormal brain MRI was detected in 50% of the patients. Almost all the patients 100% diagnosed as having valvular lesions before being diagnosed with epilepsy. Conclusion: There is a strong relationship between valvular lesions and epilepsy, most probably due to association with coexist arrhythmias resulting in cerebral infarction, tight valvular lesions, and rarely follow valvotomy valvular replacement.

Potential utility of metagenomic sequencing for improving etiologic diagnosis of infective endocarditis

Aim: To explore potential utility of metagenomic sequencing for improving etiologic diagnosis of infective endocarditis (IE) caused by fastidious bacteria. Materials & methods: Plasma and heart valves of two patients, who were diagnosed with IE caused by Bartonella quintana and Propionibacterium species, were sequenced by using Illumina MiSeq and Nanopore MinION. Results: For patient 1, B. quintana was detected in the plasma pool collected 4 days before valvular replacement surgery. For patient 2, Propionibacterium sp. oral taxon 193 was detected in the plasma sample collected on hospital day 1. Nearly complete bacterial genomes (>98%) were retrieved from resected heart valves of both patients, enabling detection of antibiotic resistance-associated features. Real-time sequencing of heart valves identified both pathogens within the first 16 min of sequencing runs. Conclusion: Metagenomic sequencing may be a helpful supplement to IE diagnostic workflow, especially when conventional tests fail to yield a diagnosis.

Mitochondrial DNA Mutations and Rheumatic Heart Diseases

Acute rheumatic fever (ARF) is an autoimmune disease affecting the heart-valve endocardium in its final stage. Although rare in developing countries, ARF persists in third-world countries, particularly Senegal, where rheumatic heart diseases (RHDs) are the most common pediatric cardiovascular pathology. This study aimed to investigate mutations in MT-CYB in ARF and RHD in Senegalese patients. MT-CYB was amplified from blood samples from ARF patients at the Clinical of Thoracic and Cardiovascular Surgery of Fann National University Hospital Centre, Dakar, Senegal (control group, healthy individuals) and sequenced. More than half of the MT-CYB mutations (58.23%) were heteroplasmic. Transitions (61.67%) were more frequent than transversions (38.33%), and non-synonymous substitutions represented 38.33% of mutations. Unoperated RHD patients harbored frequent MT-CYB polymorphisms (7.14 ± 14.70 mutations per sample) and accounted for 72.73% of mutations. Paradoxically, subjects undergoing valvular replacement harbored infrequent polymorphisms (1.39 ± 2.97 mutations per patient) and lacked 36 mutations present in unoperated subjects. A genetic differentiation was observed between these two populations, and the mutations in operated subjects were neutral, while those in unoperated subjects were under positive selection. These results indicate a narrow link (perhaps even causal) between MT-CYB mutations and ARF and its complications (i.e., RHDs) and that these mutations are largely deleterious.