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Resumen: Introducción y objetivos: Se pretende demostrar la seguridad de la reparación valvular mitral en endocarditis. Material y método: Del 2008 al 2019, hubo un total de 22 casos de reparación mitral de etiología endocardítica en nuestro centro (14 de ellas corresponden a los tres últimos años). Edad media de 60,8 años, la mayoría varones (72,7%), con un EuroSCORE-II medio del 5,9 ± 7,9%. El 63,6% se trataban de endocarditis activas en el momento de la intervención. Resultados: En la mayoría de los casos existía prolapso del velo posterior (54,5%) o de ambos velos (13,6%). La técnica de reparación más usada fue la resección (36,4%), seguida del implante de neocuerdas (22,7%) y la combinación de neocuerdas con cierre de cleft (18,2%). Se empleó anillo en la mayoría de los casos (81,8%). Sólo un caso mantuvo hemocultivos positivos postoperatorios (infección por Candida parapsilosis). Con un seguimiento de 22,1 ± 20,0 meses, no hubo ningún éxitus y sólo un caso de necesidad de reintervención. Conclusiones: En la literatura, la reparación valvular mitral ha demostrado su superioridad en mortalidad, preservación de la función ventricular izquierda y disminución de eventos tromboembólicos respecto a la sustitución valvular mitral. No obstante, la tasa de reparación mitral en endocarditis es menor que la de enfermedad degenerativa. A la vista de nuestros resultados, con ausencia de mortalidad y baja tasa de fallos de reparación, asociado al aumento del número de casos y complejidad cada año, es una estrategia de elección siempre que sea técnicamente posible. Abstract: Introduction and objectives: The aim is to demonstrate the safety of mitral valve repair in endocarditis Material and method: From 2008 to 2019, there were a total of 22 cases of mitral repair of endocardial etiology in our center (14 of them correspond to the last 3 years). Average age of 60.8 years, most of them males (72.7%), with a mean EuroSCORE-II of 5.9 ± 7.9%. 63.6% were active endocarditis at the time of the intervention. Results: In most cases there was prolapse of the posterior leaflet (54.5%) or both leaflet (13.6%). The most used repair technique was resection (36.4%), followed by neo-chord implantation (22.7%) and the combination of neo-chords with cleft closure (18.2%). Ring was used in most cases (81.8%). Only 1 case maintained positive postoperative blood cultures (Candida parapsilosis infection). With a follow-up of 22.1 ± 20.0 months, there were no deaths and only 1 case of need for reoperation. Conclusions: In the literature, mitral valve repair has shown superiority in mortality, preservation of left ventricular function, and decrease in thromboembolic events compared to mitral valve replacement. However, the mitral repair rate in endocarditis is lower than degenerative disease. In view of our results, with absence of mortality and low rate of repair failure, associated with the increase in the number of cases and complexity each year, it is a strategy of choice whenever technically possible.

Resumen: La endocarditis infecciosa es una enfermedad mortal, que a pesar de las mejoras en su manejo sigue estando asociada a gran mortalidad y complicaciones graves. Se presenta el caso clínico de un hombre de 35 años con cuadro neurológico asociado a masa valvular aórtica con doble lesión valvular. Sospechando endocarditis infecciosa, fue intervenido de sustitución valvular aórtica. El paciente tenía antecedentes de espondiloartropatía tratada con certolizumab y de betatalasemia. Presentó en el postoperatorio un taponamiento cardiaco tardío, complicaciones en la cicatrización de la herida quirúrgica y un bloqueo aurículo-ventricular que requirió de implante de marcapasos. Al cuarto mes postoperatorio fue reintervenido con el hallazgo de un seudoaneurisma subanular, encontrando una desestructuración del anillo aórtico nativo. Se realizó una nueva reintervención pasados 5 meses, decidiéndose implante de homoinjerto aórtico en posición subcoronaria. Se realizó un exhaustivo diagnóstico diferencial sin confirmación del agente etiológico hasta la positividad de Tropheryma whipplei en el material quirúrgico de la última cirugía. Abstract: Infective endocarditis is a fatal disease, which, despite improvements in its management, is still associated with high mortality and serious complications. A case is presented of a 35 year-old man with neurological symptoms associated with an aortic valve mass with a double valvular lesion. Suspecting infectious endocarditis, aortic valve replacement was performed. The patient had a history of spondyloarthropathy (treated with certolizumab) and beta-thalassaemia. In the postoperative period, he had a late cardiac tamponade, complications in the healing of the surgical wound, and anatrial-ventricular block requiring pacemaker implantation. He was re-intervened in the fourth post-operative month, with the finding of a sub-annular pseudoaneurysm, and a disruption of the native aortic ring. In a further intervention after 5 months it was decided to implant an aortic homograft in a sub-coronary position. An exhaustive differential diagnosis was made without confirmation of the aetiological agent until Tropheryma whipplei was found in the surgical material of the last surgery. Palabras clave: Endocarditis, Enfermedades de las válvulas cardiacas, Enfermedades reumáticas, Tropheryma, Keywords: Endocarditis, Heart valve diseases, Rheumatic diseases, Tropheryma

Infections are one of the leading causes of morbidity and mortality in heart transplantation (HTx). Cytomegalovirus (CMV) is the most common viral infection during the first year after HTx, but it is more unusual after this time. We present the case of a patient who underwent an HTx due to a severe ischemic heart disease. Although the patient did not have a high risk for CMV, infection, he suffered a reactivation during the first year and then up to six more episodes, especially in his eyes. The patient received different treatments against CMV and the immunosuppression was changed several times. Finally, everolimus was introduced instead of cyclosporine, and mycophenolate mofetil was withdrawn. The presented case provides an example of how the immunosupresion plays a key role in some infections in spite of being a suitable antiviral treatment.

The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.