ABSTRACT Introduction: This study was aimed to evaluate the sex-based differences in baseline characteristics and one-year outcomes of men and women undergoing mitral valve repair for infective endocarditis. Methods: This cross-sectional study was performed at Imam Ali Hospital affiliated with the Kermanshah University of Medical Science. From March 21, 2014, to October 21, 2021, all patients who underwent mitral valve repair for infective endocarditis were enrolled in this study. Data were obtained using a checklist developed based on the study’s objectives. Independent samples t-tests, paired samples t-tests, and chi-squared test (or Fisher’s exact test) were used to assess the differences between subgroups. Results: Of 75 patients, 26 were women (34.7%) and 49 were men (65.3%). Women were more likely to have diabetes mellitus (20.4% vs. 57.7%, P=0.0001), hypertension (49% vs. 80.8%, P=0.007), and hypercholesterolemia (55.1% vs. 80.8%, P=0.027). Conversely, men were more likely to have a history of smoking (38.8% vs. 7.7%, P=0.004). After one year, women had significantly higher mortality (0% vs. 7.7%, P=0.049), major adverse cardiac and cerebrovascular events (51.0 vs. 76.9, P=0.029), mitral valve reoperation (8.1% vs. 34.6%, P=0.003), and treatment failure (30.6% vs. 61.5%, P=0.009) rates than men. Conclusion: Mortality, major adverse cardiac and cerebrovascular events, mitral valve reoperation, and treatment failure rates were higher in women than in men. The worse outcomes in women may be explained by their more adverse clinical risk profile.

Abstract A 25-year-old woman with a history of recent dyspnea and palpitation was admitted to our center. Transthoracic echocardiography (TTE) showed an echogenic and septal muscular ridge along the left atrium which were indicative of cor triatriatum sinister (CTS). Further evaluation with transesophageal echocardiography (TEE) showed that a lower chamber of divided left atrium receiving lower right inferior pulmonary vein, mitral valve, left superior vena cava (LSVC) and unroofed coronary sinus (CS). Also, the lower chamber had an unrestrictive communication with the right atrium. The upper accessory chamber receiving one left and one right upper pulmonary vein and communicated with the right atrium by a small atrial septal defect (ASD). However, upper and lower pulmonary venous systems separated directly from each other by a muscular ridge without the presence of any window or hole to allows blood flow between these two accessory chambers. Although the absence of septum associated with the presence of LSVC and unroofed CS makes our case a unique or very rare type of this complex anomaly in an adult case. In our case, surgical removal of dividing muscular membrane with redirection of LSVC and unroofed CS to the right atrium are warranted.

Resumen Se trata de una paciente de sexo femenino, de 25 años de edad, con antecedentes recientes de disnea y palpitaciones que ingresó a nuestro centro. Un ecocardiograma transtorácico (ETT) evidenció un reborde ecogénico muscular del tabique de la aurícula izquierda indicativo de cor triatriatum sinistrum (CTS). En un estudio más a fondo con ecocardiografía transesofágica (ETE) se evidenció que una cámara inferior de la aurícula izquierda dividida recibía la vena pulmonar inferior derecha, la válvula mitral, la vena cava superior izquierda (VCSI) y el seno coronario (SC) destechado. Además, la cámara inferior tenía comunicación libre con la aurícula derecha. La cámara superior secundaria recibía una vena pulmonar superior izquierda y una derecha y se comunicaba con la aurícula derecha a través de una comunicación interauricular (CIA) pequeña. Sin embargo, los sistemas venosos pulmonares superiores e inferiores se encontraban separados entre sí por un reborde muscular sin la presencia de alguna ventana u orificio que permitiera el flujo de sangre entre estas dos cámaras secundarias. La ausencia del tabique junto con la presencia de la VCSI y el SC destechado hacen que nuestro caso sea un tipo único o extremadamente inusual de esta anomalía compleja en un caso en un adulto. En este caso, se justifica la extirpación quirúrgica de la membrana muscular divisoria con redireccionamiento de la VCSI y el SC destechado a la aurícula derecha.

Un adulto con un gran ductus arterioso permeable puede presentar fatiga, disnea y palpitaciones y menos frecuentemente presentar endocarditis. El caso muestra el papel de la vegetación de la endocarditis en la anemia hemolítica con el conducto arterioso patente (CAP) en adultos. A pesar del tratamiento de la endocarditis con la terapia antibiótica completa, la normalidad en la proteína C-reactiva, la tasa de sedimentación globular y leucocitaria, y un estado de bienestar general del paciente, la ecocardiografía trans torácica reveló gran vegetación en el lumen de CAP y el cierre completo quirúrgico de PDA, sin hemólisis y la desaparición de glóbulos rojos fragmentados en frotis de sangre periférica. Los 3 meses de seguimiento revelaron oclusión completa de CAP y la desaparición de la anemia hemolítica confirmada por examen clínico y laboratorio.

An adult with a large patent ductus arteriosus may present with fatigue, dyspnea or palpitations or in rare presentation with endocarditis. The case illustrated unique role of vegetation of endocarditis in hemolytic anemia in adult with patent ductus arteriosus (PDA). Despite treatment of endocarditis with complete course of appropriate antibiotic therapy and normality of C- reactive protein, erythrocyte sedimentation rate and leukocytosis and wellness of general condition, transthoracic echocardiography revealed large vegetation in PDA lumen, surgical closure of PDA completely relieved hemolysis, and fragmented red cell disappeared from peripheral blood smear. The 3-month follow-up revealed complete occlusion of PDA and abolishment of hemolytic anemia confirmed by clinical and laboratory examination.