EDITOR'S PAGE

AT A GLANCE

   Endocarditis remains a serious disease.  Before the easy accessibility of antimicrobial therapy, infective endocarditis (IE) was a fatal disease.  Now, the majority of patients with endocarditis survive their infection.  However, even today, the disease is still an important cause of morbidity and mortality.  New trends in the epidemiology of IE have occurred during the past three decades.  The incidence of predisposing conditions, i.e., rheumatic heart disease and intravenous drug use, has varied over time. In this issue of the Journal, Suleiman and Prashanth from the Royal Hospital, Muscat, Oman, (p.89-95), report the epidemiological characteristics, risk factors, clinical presentation, microbiology, morbidity, and mortality of endocarditis in their center based on a study cohort prospectively evaluated over a 10-year period.  Some of their findings such as rheumatic heart disease being the major predisposing factor, the young age, and predominance of streptococci isolates are not surprising for the social conditions in the area.  What was surprising was the high incidence of culture negative endocarditis in their series.  The paper is important for our region because it is the first long-term prospective analysis of endocarditis.  It would be interesting to compare the pattern of IE among the GCC states.  Hopefully, a GCC registry could be set up to monitor any change in host susceptibility, treatment patterns, and identify areas of cooperation.

   Ion channels are a diverse group of pore-forming transmembrane proteins that selectively conduct ions and play physiological roles in most cell types, including neurons, skeletal muscle, smooth muscle, and cardiac muscle.  Inherited mutation in genes encoding ion channels have been associated with various diseases, among them, cardiac arrhythmias.  Disorders in ion channels are termed “channelopathies.” The article by Dr.  Marban from The John’s Hopkins University, Maryland, USA (p.94-103 ), is an excellent introduction and review of cardiac channelopathies.  Because of the increased risk of sudden death in patients predisposed to arrhythmias, an understanding of the molecular basis of cardiac excitability is necessary in the search for new and effective treatment of cardiac arrhythmias. 

   Hypoplastic left heart syndrome (HLHS) is one of the most complex cardiac defects in the newborn and its management is probably the most challenging of all congenital heart defects.  There was no hope for neonates born with such a complex malformation until 1980 when Dr. William Norwood reported successful palliation of HLHS for the first time.  Since then, there has been a significant evolution in the surgical strategy for HLHS patients.  Dr. Richard Jonas from Boston Children’s Hospital, Harvard Medical School, Massachusetts, USA (p.104-109), provides an excellent and thorough update on the operative technique and modifications such as incorporation of the Sano shunt, which has significantly simplified and improved immediate postoperative management. He reviews the postoperative outcome in different centers as well as the experience in their center.  The news is good.  Early survival has dramatically improved over time.  The operative mortality of stage 1 Norwood in their center in 2002 is now less than 10%.

   For many patients with valvular heart disease, valve replacement is still the only option.  Because of the inherent management problems associated with mechanical valves such as anticoagulation, surgeons are continually searching for novel approaches to preserve the patient’s native valve.  There has been significant advancement in surgical techniques to preserve the mitral valve.  However, results of aortic valve repair have been less than satisfactory.  The Ross procedure was introduced as a viable alternative to mechanical valve in the aortic position.   Pettersson and Grimm from The Cleveland Clinic Foundation, Ohio, USA (p.110-122), give a comprehensive review of this challenging and demanding operation as applied to young adult patients.  The operative outcome, complications on follow-up, and re-operation rate are discussed thoroughly, with emphasis on their experience in their institution.  

Dr. Amer Chaikhouni from Al-Salam Hospital, Aleppo, Syria (p.123) proposes in his accompanying editorial on the paper by Pettersson and Grimm that Ross may be a viable alternative in underdeveloped countries since the technique obviates the need for anticoagulation.  Is falling in love a disease?  Dr. H.A. Hajar Albinali reflects and discusses love in the history of medicine in his Chairman’s Reflections (p.127-133).  He narrates an Arab love story in a unique way, presenting it as a “Case History,” weaving delightful translations of beautiful Arabic verses on love.  He traces the evolution of our understanding of this powerful emotion from the early theories of ancient physicians to new insights on the neurobiology of love. It is a topic that is universal, timeless, and appeals to all human beings.

                                                                                                                                           Rachel Hajar, MD