IntroductionCardiac surgery is frequently needed during active phase of infective endocarditis (IE). The purpose of this study was to analyze the immediate and late results and determine the risk factors for death.MethodsWe retrospectively reviewed 101 patients with IE operated in the active phase. The mean age was 40.5 ± 12.5 years. 16 patients (15.8%) were diagnosed with prosthetic valve endocarditis (PVE). 81 (80.9%) were in NYHA functional class III-IV. Blood cultures were positive in only 24 cases (23.9%).Resultsin-hospital mortality rate was 17.9% (18 cases). Multivariate analysis indentified five determinant predictor factors: congestive heart failure (CHF), renal insufficiency, high Euroscore, prolonged cardiopulmonary bypass time (> 120 min) and long ICU stay. The median follow-up period was 4.2 (2-6.5) years. Overall survival rate for all patients who survived surgery was 97% at 5 years and 91% at 10 years.ConclusionDespite high in-hospital mortality rate, when patients receive operation early in the active phase of their illness, late outcome may be good.

Background: Coronary artery bypass grafting has been widely admitted in the therapeutic arsenal of coronary artery disease in diabetics with low morbi-mortality. However, it requires special management which may be challenging in low-volume centers especially in African countries. We aimed to analyze the outcome of coronary artery bypass graft in our diabetic population and define predictors of adverse events. Patients and methods: We retrospectively enrolled 529 consecutive diabetic patients (type 2) who underwent onpump coronary artery bypass grafting at our institution between January 2000 and June 2018. The mean age was 61.1 ± 8.3 years with 4.04 as sex ratio (M/F) and 2.95 as mean EuroSCORE II. History of acute myocardial infarction, left main coronary artery stenosis, and three-vessel disease was present in respectively 58%, 26.1%, and 72.2% of patients. The average number of bypass was 2.4 ± 0.8. Duration of cardiopulmonary bypass and aortic crossclamping were respectively 124.8 ± 43.5 and 79.7 ± 32.9 min. Results: In-hospital mortality was 5.9% (n = 31) and the late mortality was 6.9% (n = 32). Duration of artificial ventilation, ICU stay, and postoperative stay were respectively 7 h, 44 h, and 13 days. Postoperative complications were myocardial infarction, superficial wound infection, mediastinitis, and low cardiac output syndrome in respectively 9.1%, 25.5%, 3.8%, and 12.7% of patients. Multivariable logistic regression analysis revealed that left ventricular ejection fraction < 40% (OR = 1.88; 95% CI 1.30-2.47; p = 0.03), poor perioperative glycemic control (OR = 1.53; 95% CI 1.12-2.38; p = 0.014), intra-aortic balloon pump insertion (OR = 2.29; 95% CI 1.47-3.10; p < 0.001), and postoperative cardiac complications (OR = 2.01; 95% CI 1.23-2.78; p < 0.001) were predictors of in-hospital mortality. Predictors of mediastinitis were obesity (OR = 5.86; 95% CI 1.43-23.95; p = 0.014), inotropic drugs use (OR = 8.14; 95% CI 1.57-42.34; p = 0.013), chest reopening for bleeding (OR = 4.01; 95% CI 0.62-25.85; p = 0.014), and blood transfusion (OR = 7.56; 95% CI 1.09-52.76; p = 0.041). Follow-up was 86.1% complete, with a mean follow-up of 63.5 ± 48.3 months (1-192 months), and cumulative survival at 5, 10, and 15 years was respectively 95.5 ± 1.1%, 86.3 ± 2.9%, and 76.9 ± 6.9%. Conclusion: Even in low-volume centers in developing areas, coronary artery bypass surgery is an effective therapy for coronary artery disease in diabetic patients despite a relative high morbidity and mortality.

Scimitar syndrome is a rare malformation defined as the partial or total anomalous pulmonary venous return of the right lung veins to the inferior vena cava just above or below the diaphragm. Severe forms of the disease are diagnosed in infancy and childhood. However, because of the mild form of the syndrome in adult patients, they remain asymptomatic and few cases are reported in the literature. We report two adults cases of this syndrome with one presenting with chest discomfort.

IntroductionTotal occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function.Case presentationWe describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery.ConclusionsTotal occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.

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Scimitar syndrome is rare malformation defined as partial or total anomalous pulmonary venous return of the right lung veins to the inferior vena cava just above or below the diaphragm. Severe forms of the disease are diagnosed in infancy and childhood. However, because of the mild form of the syndrome in adult patients, they remain asymptomatic and few cases are reported in the literature. We report an unusual presentation of this syndrome mimicking unstable angina in one of the two described cases.