22. European Stroke Conference Table 2: Questions asked specific to patient’s medical status and treatment 1. Do you understand that you need a breathing machine? 2. Do you understand that you will probably need a breathing machine for the rest of your life? 3. Do you want to continue with therapy? 4. Do you understand that you will need help for the rest of your life? 5. Would you like to be resuscitated if your heart stops? 6. Would you like us to treat infections? 7. If an infection gets worse would you like to be allowed to die? 362 © 2013 S. Karger AG, Basel Scientific Programme 152 Interesting and challenging cases TCD Embolus Detection guided valve replacement in Native Infective Endocarditis: a case re-port. R.W. Keunen1, B Wokke2, M Khalilzadaa3, G Hoohenkerk4, M.A. Falsafi5, R ten Berge6, K Prenger7 Haga Teaching Hospitals, The Hague, THE NETHERLANDS1 Background: Strokes in patients with native endocarditis are predictors of poor outcome. Stroke risk stratification of these patients is based on the echo criteria of unstable valve lesions and clinical signs and symtoms of ongoing systemic embolism. However, stability of the valve can sometimes be difficult to predict from echo images alone and clinical evidence may be subtle. Lepur et al. showed that asymptomatic cerebral emboli detected by transcranial Doppler are strong predictors of stroke in native endocarditis 1. We present a 70 years old male with asymptomatic cerebral emboli who was scheduled for rapid valve replacement to prevent strokes. Methods The patient was examined by a 2 MHz transcranial Doppler system (EMS9U/DelicaSys-tem/ Shenzen Delicate Electronics Co. Ltd./China) in combination with special software to detect the ongoing cerebral embolism (The Embolus Detection System (EDS developed by Keunen/Dis-tributed by SMT Medical /Wurzburg/Germany) . Results Presurgery EDS showed frequently very high intensity emboli (mean intensity 4.5 dB range 3-8 dB ; frequency of 1 to 2 per min) indicative for a very unstable cardiac valve. Postsur-gery EDS showed a significant decreased number and intensity of the emboli. The patient recovered fully from surgery with a good cardiac performance and without any neurological deficits. Valve specimen showed multiple unstable calcified lesions. Conculsion TCD embolus detection allows the detection of asymptomatic emboli which are the pre-dictors of imminent stroke. This knowledge might be valuable in the timing of valve replacement References 1 D Lepur et al. Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: An open cohort study. Scandinavian Journal of Infectious Diseases, 2009; 41: 708-713.
Karger_ESC London_2013
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