Background and Aims: Cardiac myxomas may present clinically with many different features. Since highly effective treatments exist, it is important that they are diagnosed quickly in order to avoid further complications. Our aim was to determine the influence of neurological presentation in diagnosis and prognosis of cardiac myxomas. Methods: We have reviewed the clinical charts of 28 patients diagnosed with cardiac myxomas seen at our centre in the last 20 years. Results: Mean age at diagnosis in patients with neurological events was 49.22 years and 60.84 years in those without neurological manifestations (p = 0.0325). Most frequent presentations were: cardiac manifestations (92.8%), general manifestations (71.4%) and embolic events (39.3%). Nine patients (32.1%) presented with cerebral embolism; 7 of whom presented with transient ischaemic attacks (TIA), which was the first manifestation in 6 of them; 3 of them later suffered complete cerebral infarction with sequelae. Echocardiography confirmed diagnosis in 26 out of 27 patients in which it was performed. None of the patients presented neurological symptoms after surgery. Conclusion: The most frequent initial neurological manifestation in our series was TIA. Nevertheless, none of the patients were diagnosed after the first neurological symptom. Although the contribution of cardiac myxomas to the total amount of TIA is low, since surgery is highly effective and of low risk, and patients with neurological manifestations are younger, it is vital to consider the possibility of cardiac myxoma after a TIA of unknown origin.

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Objective-To analyse the long term results of mechanical prostheses for treating active infective endocarditis. Design-Prospective cohort study of a consecutive series of patients diagnosed with infective endocarditis and operated on in the active phase of the infection for insertion of a mechanical prosthesis. Setting-Tertiary referral centre in a metropolitan area. Results-Between 1975 and 1997, 637 cases of infective endocarditis were diagnosed in the centre. Of these, 436 were left sided (with overall mortality of 20.3%). Surgical treatment in the active phase of the infection was needed in 141 patients (72% native, 28% prosthetic infective endocarditis). Mechanical prostheses were used in 131 patients. Operative mortality was 30.5% (40 patients). Ninety one survivors were followed up prospectively for (mean (SD)) 5.4 (4.5) years. Thirteen patients developed prosthetic valve dysfunction. Nine patients suVered reinfection: four of these (4%) were early and five were late. The median time from surgery for late reinfection was 1.4 years. During follow up, 12 patients died. Excluding operative mortality, actuarial survival was 86.6% at five years and 83.7% at 10 years; actuarial survival free from death, reoperation, and reinfection was 73.1% at five years and 59.8% at 10 years. Conclusions-In patients surviving acute infective endocarditis and receiving mechanical prostheses, the rate of early reinfection compares well with reported results of homografts. In addition, prosthesis dysfunction rate is low and long term survival is good. These data should prove useful for comparison with long term studies, when available, using other types of valve surgery in active infective endocarditis. (Heart 2001;86:63-68) Keywords: infective endocarditis; surgery; mechanical prosthesisThe diagnosis and treatment of infective endocarditis has evolved greatly in recent years. Nevertheless, the morbidity and mortality of this disease remains high.1-4 Initially, medical treatment with an eVective antibiotic is mandatory. If the disease progresses or heart failure symptoms develop because of valve disruption, surgery should be considered. [5][6][7][8][9] Thus the surgical treatment must often be performed in the active phase of the infection. The best timing for the operation and the preferred surgical technique are matters of debate. The most controversial points are the optimal device for the valve replacement and the long term results of such surgery.Our aim in this study was to analyse the long term results of mechanical prostheses for the treatment of active infective endocarditis in our institution during a 22 year period. We report a large prospective series with standardised preoperative management, surgical indications, and long term follow up. Methods PATIENTSAll patients diagnosed with infective endocarditis at our institution between 1975 and 1997 were included in the study. The infectious diseases department supervises all blood cultures taken in our institution on a daily basis in the microbiology laborato...

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