Infective endocarditis is a serious, life-threatening condition with mortality of 30% at one year. Established treatment is a combination of anti-microbial therapy and close interface between multiple specialist teams of cardiologists, microbiologists and cardiac surgeons to ensure availability of early surgery to those patients who require it. There are evidence-based established indications for surgery and a shifting body of evidence advocating earlier surgical intervention. The development of complications is often the driving cause of referral for surgical intervention. Here we discuss the management of infective endocarditis, considering both antimicrobial therapy and indications for surgery to treat this debilitating disease.
SUMMA RYAortic valve disease is common and has significant impact on prognosis and quality of life. In this educational review, we cover the pathophysiology, presentation and assessment of aortic stenosis (AS) and aortic regurgitation (AR), including the role of imaging modalities beyond echocardiography. We review current treatment strategies and emphasise the use and indications for transcatheter aortic valve implantation (TAVI) in view of recent data highlighting its emergence as a novel treatment option for patients with AS, who are unsuitable for conventional aortic valve replacement (AVR). We also describe novel surgical approaches for AR and potential future strategies for percutaneous intervention.
Review criteriaThis review provides a summary of the pathophysiology and clinical manifestations of aortic valve disease, as well as updating the reader on new treatment options. There is a wealth of literature on the subject, and we focus on seminal reviews and trials, using forward and back citation to identify new developments.
Summary
In this review, we discuss right‐sided heart valve disease, namely tricuspid regurgitation (TR), tricuspid stenosis, pulmonary regurgitation, pulmonary stenosis and right‐sided endocarditis. These are frequently seen in conjunction with other diseases, making assessment of their significance more difficult, but it has become increasingly clear that moderate or severe right‐sided heart valve disease, in particular TR, is associated with worse prognosis. There remain large gaps in our knowledge of medical and interventional treatment, but in this article we outline what is known about the causes, presentation and management of these commonly seen conditions.
Valvular heart disease is one of the most dynamic and exciting fields in cardiovascular medicine, with significant developments in investigation and management over recent years. In this review, we cover some of the most exciting areas, including the potential for treatment strategies aimed at halting the progression of early aortic stenosis, the use of positron emission tomography in assessing disease activity, novel percutaneous strategies for treating valve disease and new directions in the prevention and management of infective endocarditis.
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