The Canadian journal of cardiology
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The neutrophil-to-lymphocyte ratio is an independent predictor of worse prognosis in both infectious and cardiovascular disease. We hypothesized that an increased neutrophil-to-lymphocyte ratio at admission would predict in-hospital unfavourable outcomes in patients with infective endocarditis (IE). ⋯ High neutrophil-to-lymphocyte ratio at admission is an independent predictor of in-hospital mortality and CNS events in patients with IE. However, prospective validation of these findings is required.
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The junction between the left brachiocephalic vein and the superior vena cava is a high-risk region during lead extraction. Venous laceration with hemodynamic collapse is the most feared complication arising in this region, but arteriovenous fistula formation after excimer laser extraction also has been reported. ⋯ A continuous murmur was heard near the extraction site and invasive angiography demonstrated a left internal mammary artery to the brachiocephalic vein fistula, which was coiled. A new continuous murmur after lead extraction is the hallmark of this rare complication.
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Not infrequently, chordae tendineae rupture, which was not recognized preoperatively using echocardiography, was found during mitral valve (MV) surgery in patients with severe mitral regurgitation (MR) diagnosed with MV prolapse. We evaluated the incidence and predictors of echocardiographically-unrecognized chordae tendineae rupture in patients with severe MR because of MV prolapse. ⋯ Unrecognized chordae tendineae rupture is a common unrecognized contributor to severe MR necessitating valve replacement in MV prolapse patients. Earlier recognition and more specific management might contribute to improved prognosis for such patients.
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There is an ongoing debate whether the tricuspid valve (TV) should be repaired with a suture annuloplasty or a prosthetic ring. ⋯ A modified De Vega suture annuloplasty was effective at eliminating TR and producing right ventricular (RV) reverse remodelling at 5-year follow-up, although TR tends to increase with time.