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Prof. Gilbert Habib,
This very exciting and interactive session tried to answer difficult questions in infective endocarditis, and to evaluate the application of 2009 ESC recommendations. Profs Robert Dion from Belgium and Bernard Iung from Paris completed the panel.
1: Difficult diagnosis of infective endocarditis: new challenges, new strategies?
The first case was presented by Peter Sogaard from Denmark. He illustrated how difficult the diagnosis of infective endocarditis may be in patients with intracardiac devices and in those with prosthetic valves. Echocardiography, even transesophageal, is sometimes of limited value in these situations. The potential value of PET scan was underlined. In some situations, PET scan may be positive early, while TEE is still negative or doubtful. Further studies are necessary to confirm these data and give more information about the exact role of this new technique in infective endocarditis.
2 .What to do in case of large vegetation; when to operate? can we apply recommendations?
This topic was covered by Arturo Evangelista, from Spain. Embolic events are a frequent and life-threatening complication of subacute bacterial endocarditis. Several factors have been associated with the risk of embolism including the size of the vegetation ,the type of microorganism, the localization of the vegetation on the mitral valve. The most potent predictor of risk of embolism is the size and mobility of the vegetation.
The main key messages from the panel were the following:
3: Neurological complications; diagnostic and therapeutic strategies
This topic was covered by Ulrika Snygg-Martin from Sweden. Brain injuries occur in 20% to 40% of patients during the active course of infective endocarditis and are mainly the consequence of vegetation embolization or ruptured mycotic aneurysm. The main points underlined were the following
Finally, in all these situations, a multidisciplinary approach is mandatory, including cardiologists, infectiologists, and cardiac surgeons.
Difficult decisions in infective endocarditis
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