Propionibacterium acnes endocarditis is an uncommon infection in pediatrics. We describe a case of P. acnes endocarditis in a 16-year-old boy that occurred 6 months after recurrent surgery for a congenital cardiopathy. Molecular identification of P. acnes was obtained. He recovered from this infection after a surgical treatment and with a prolonged antibiotic regimen including ceftriaxone.
The prevalence and location of coronary artery disease (CAD) in anomalous aortic origin of a coronary artery (AAOCA) remain poorly documented in adults. We sought to assess the presence of CAD in proximal (or ectopic) and distal (or nonectopic) segments of AAOCA. We hypothesized that the representation of CAD may differ among the different courses of AAOCA. The presence of CAD was analyzed on coronary angiography and/or coronary computed tomography angiography in 390 patients (median age 64 years; 73% male) with AAOCA included in the anomalous coronary arteries multicentric registry. AAOCA mainly involved circumflex artery (54.4%) and right coronary artery (RCA) (31.3%). All circumflex arteries had a retroaortic course; RCA mostly an interarterial course (98.4%). No CAD was found in the proximal segment of interarterial AAOCA, whereas 43.8% of retroaortic AAOCA, 28% of prepulmonic AAOCA and 20.8% subpulmonic AAOCA had CAD in their proximal segments ( P < 0.001). CAD was more prevalent in proximal than in distal segments of retroaortic AAOCA (OR: 3.1, 95% CI: 1.8-5.4, P < 0.001). On multivariate analysis, a retroaortic course was associated with an increased prevalence of CAD in the proximal segment (adjusted OR 3.4, 95% CI: 1.3-10.7, P = 0.022). Increased prevalence of CAD was found in the proximal segment of retroaortic AAOCA compared to the proximal segments of other AAOCA, whereas no CAD was observed in the proximal segment of interarterial AAOCA. The mechanisms underlying these differences are not yet clearly identified.
Since the development of the first vascular grafts, fabrication of vessel replacements with diameters smaller than 6 mm remains a challenge. The present work aimed to develop PVA (poly (vinyl alcohol))-gelatin hybrids as tubes suitable for replacement of very small vessels and to evaluate their performance using a rat abdominal aorta interposition model. PVA-gelatin hybrid tubes with internal and external diameters of 1.4 mm and 1.8 mm, respectively, composed of 4 different gelatin ratios were prepared using a one-step strategy with both chemical and physical crosslinking. By 3D Time of Flight MRI, Doppler-Ultrasound, Computed Tomography angiography and histology, we demonstrated good patency rates with the 1% gelatin composition until the end of the study at 3 months (50% compared to 0% of PVA control grafts). A reduction of the patency rate during the time of implantation suggested some loss of properties of the hybrid material in vivo, further confirmed by mechanical evaluation until one year. In particular, stiffening and reduction of compliance of the PVA-gelatin grafts was demonstrated, which might explain the observed long-term changes in patency rate. These encouraging results confirm the potential of PVA-gelatin hybrids as ready-to-use vascular grafts for very small vessel replacement.
Rheumatic fever is a delayed sequel to throat infection by a group A streptococcus. More than one third of affected children develop carditis, followed many years later – especially in the case of recurrent rheumatic infections – by progressive and permanent valvular lesions, known as rheumatic heart disease. 2 Rheumatic heart disease is now largely restricted to developing countries and most of the reduction in its incidence in wealthy countries is attributable to better living conditions with consequent reductions in the transmission of group A streptococci. Nevertheless, with the decline in rheumatic fever in industrialized countries and the emphasis on diseases such as malaria and HIV in developing countries, there has been a parallel reduction in research into this still prevalent and important condition. 3 Rheumatic heart disease remains an obvious public health burden across the developing world causing more than 200 000 deaths a year. 4 An exaggerated immune response to specific bacterial epitopes in a susceptible host is thought to be the basis of the disease. 5 Rheumatic heart disease usually results from the cumulative damage from recurrent episodes of acute rheumatic fever. It has been reported that after a first episode of carditis, cardiac ausculta tion becomes unremarkable in one-third of children but even these children may progress to significant rheumatic valve disease in later life, as confirmed by echocardiography. 6 Thus early detection of “subclini cal” rheumatic valve disease is vital, as it presents an opportunity for case detection at a time when prophylactic penicillin – to prevent recurrent episodes – can prevent progression to important valve disease in young adult life. Early detection of rheumatic heart disease in school children is traditionally done by listening for murmurs by stethoscope, followed by echocardiographic confir mation only in suspected cases. Recently, we did systematic echocardiographic screening in schools in Cambodia and Mozambique, to assess whether early case detection could be improved by using portable ultrasound. 7 We achieved a case detection rate by echocardiography approximately 10-fold that achieved by clinical examination only. Such screening thus makes it possible to identify children at risk of developing severe rheumatic valve disease for whom secondary prevention with penicillin prophylaxis may be effective. Acute rheumatic fever episodes can be prevented by antibiotic treatment of group A streptococcal throat infections, a strategy known as primary prophy
