Early diagnosis of infective endocarditis (IE) is based on the yielding of blood cultures and echocardiographic findings. However, they have limitations and sometimes the diagnosis is inconclusive, particularly in patients with prosthetic valves (PVs) and implantable cardiac electronic devices (ICEDs). The primary aim of this study was to evaluate the diagnostic accuracy of ¹⁸F-FDG PET/CT in patients with suspected IE and ICED infection. Methods: A prospective study with 80 consecutive patients with suspected IE and ICED infection (65 men and 15 women with a mean age of 68 ± 13 y) between June 2013 and May 2015 was performed in our hospital. The inclusion criteria were clinically suspected IE and ICED infection at the following locations: native valve (NV) (n = 21), PV (n = 29), or ICED (n = 30) (automatic implantable defibrillator [n = 11] or pacemaker [n = 19]). Whole-body ¹⁸F-FDG PET/CT with a myocardial uptake suppression protocol with unfractionated heparin was performed in all patients. The final diagnosis of infection was established by the IE Study Group according to the clinical, echocardiographic, and microbiologic findings. Results: A final diagnosis of infection was confirmed in 31 patients: NV (n = 6), PV (n = 12), and ICED (n = 13). Sensitivity, specificity, positive predictive value, and negative predictive value for ¹⁸F-FDG PET/CT were 82%, 96%, 94%, and 87%, respectively. ¹⁸F-FDG PET/CT was false-negative in all cases with infected NV. ¹⁸F-FDG PET/CT was able to reclassify 63 of 70 (90%) patients initially classified as possible IE by modified Duke criteria. In 18 of 70 cases, ¹⁸F-FDG PET/CT changed possible to definite IE (26%) and in 45 of 70 cases changed possible to rejected IE (64%). Additionally, ¹⁸F-FDG PET/CT identified 8 cases of septic embolism and 3 of colorectal cancer in patients with a final diagnosis of IE. Conclusion: ¹⁸F-FDG PET/CT proved to be a useful diagnostic tool in suspected IE and ICED infection and should be included in the diagnostic algorithm for early diagnosis. ¹⁸F-FDG PET/CT is not useful in the diagnosis of IE in NV but should be also considered in the initial assessment of this complex scenario to rule out extracardiac complications and possible neoplasms.

The aims of the present study were to identify the mechanisms of residual or recurrent left ventricular outflow tract obstruction in patients undergoing repeat septal myectomy for hypertrophic cardiomyopathy and to assess the early and late results of reoperation. From January 1980 to June 2012, we performed 52 repeat myectomies in 51 patients. We reviewed the medical records and preoperative transthoracic echocardiograms to evaluate the adequacy of the previous resection and mechanism of left ventricular outflow tract obstruction. The complications of previous and repeat myectomy, New York Heart Association class, and survival were analyzed. The mean interval from previous myectomy to reoperation was 43 ± 51 months. In 6 patients (12%) residual or recurrent gradients were caused by isolated midventricular obstruction. In the remaining 46 operations, the mechanism of residual or recurrent gradients was identified as systolic anterior motion of mitral valve-related subaortic obstruction caused by inadequate length of previous subaortic septal excision in 31 patients (59% of the total), both an inadequate length and an inadequate depth of septectomy in 13 patients (25%), and both residual subaortic obstruction due to systolic anterior motion of the mitral valve and midventricular obstruction in 2 patients (4%). Preoperatively, 96% of patients were in New York Heart Association class III or IV; postoperatively, 93.8% were in class I or II (P < .001). The 10-year survival after reoperation was 98% and similar to that of an age- and gender-matched Minnesota population (P = .46). The most common cause of recurrent left ventricular outflow tract obstruction and symptoms in patients undergoing septal myectomy has been an inadequate length of septal excision. Reoperation is safe, with excellent long-term survival and functional improvement.

The number of patients undergoing surgery on the thoracic and thoraco-abdominal aorta has been steadily increasing over the past decade. This document aims to give guidance to authors reporting on results in aortic surgery by clarifying definitions of aortic pathologies, open and endovascular techniques and by listing clinical parameters that should be provided for full presentation of patients’ clinical profile and in particular, their outcome. The aim is to help find a common language in the treatment of aortic disease and to contribute to a better understanding of this patient population.