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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Seven patients are described in whom chronic Q fever was detected by serology (Coxiella burneti phase I antibody titre greater than 1:200) during routine screening at admission for cardiac catheterisation. None had clinical evidence of endocarditis, hepatitis or other foci of infection. Three of the patients were kept under observation without antibiotic treatment for periods of six, 18 and 20 months. In two patients of this group, cardiac tissue was obtained at operation and in one patient seroconversion following guinea-pig inoculation indicated the presence of Coxiella burneti infection. Four patients were given antibiotic treatment when Q fever was confirmed by serology. Courses of antibiotic treatment with a combination of two drugs were maintained for four to six years and in three of these patients phase I antibody titres fell to very low levels with no appearance of overt infection. The fourth patient died after resection of an aortic aneurysm, seven months after starting antibiotic treatment. Cases reported in the literature indicate that while endocarditis is the most common manifestation of chronic Q fever, the infection can persist at other sites. Of the seven cases of subclinical chronic Q fever reported here, the infection was localised in only one. Patients with this subclinical form of infection pose the therapeutic dilemma of whether or not they should receive antibiotic treatment.
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PMID:Subclinical chronic Q fever. 408 Sep 56

From January 1979 to April 1983, 72 patients (pts) with bacterial endocarditis were treated. During their first stay in hospital 36 of them (age range: 23-67 years) underwent cardiac surgery because of severe congestive heart failure, unsuccessful antibiotic treatment of the infection and/or embolic events. In all these cases cardiac surgery was performed without preoperative catheterization. Surgery was recommended on the basis of clinical as well as M-mode and 2D echocardiographic findings. In 32 of the 36 pts the echocardiographic study completely predicted the surgical findings (23x the aortic valve, 1x the mitral valve, 1x the tricuspid valve, 5x the mitral and aortic valve, 1x the aortic valve and a VSD and 1x the triscuspid valve and a VSD were involved). The preoperative echocardiographic diagnosis was incomplete in 4 of the 36 pts. One aortic aneurysm, one aortic root abscess and 2x vegetations on the mitral valve were not detected by echocardiography. Surgery was recommended in these 4 pts because of additional aortic valve endocarditis proven by echocardiography. We conclude that combined M-mode and 2D echocardiography allows the accurate prediction of morphological alterations of the heart in the setting of acute bacterial endocarditis. Thus cardiac surgery can be recommended in pts with acute bacterial endocarditis without preoperative heart catheterization and coronary angiography.
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PMID:Correlation of echocardiographic and surgical findings in acute bacterial endocarditis. 651 89

A technique for the management of dissecting aortic aneurysm with aortic valve insufficiency, using allograft replacement and coronary artery reimplantation is presented. The author's experience is based in 56 allograft valve implantations. The softness of the biological material facilitates the coaptation between the valve and an often irregular, calcified bed, as well as reimplantation of coronary arteries. Allograft transplantation produces an immunological response, but this has no notable clinical significance. Long-term results are very satisfactory. Cases of endocarditis, cusp rupture and severe calcification have not been observed.
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PMID:Long-term evaluation of allograft aorta and valve replacement. 666 31

A total of 200 aortic vale re-replacements were performed between Jan. 1, 1975, and July 1, 1979. The re-replacements (RRP) were an isolated procedure or combined with coronary artery bypass grafting or resection of ascending aortic aneurysm. Ten patients (5%) died in hospital, compared with 24 (2.9%) among 842 patients undergoing isolated or combined initial aortic valve replacement (AVR) (p = 0.12). The mode of death was cardiac failure in six of the 10 patients, hemorrhage in two (from accidents at repeat sternotomy), and neurologic deficits in two (each with innominate vein transection at repeat sternotomy repaired by ligation). There were seven (3.9%) hospital deaths among 181 first RRP (p for difference from initial AVR = 0.5), but three (15%) of 19 died after the second or third RRP (p = 0.001). By simple contingency table analysis, preoperative New York Heart Association (NYHA) Class IV increased the risk of hospital death after RRP (p = 0.002), as did prosthetic valve endocarditis (p = 0.0005) and the use of cold ischemic arrest (p = 0.03). Logistic multivariate analysis showed advanced NYHA functional class (p = 0.02), use of cold ischemic arrest (p = 0.09), and increased aortic cross-clamps time (p = 0.03) to be incremental risk factors. Recommendations for reducing hospital deaths in the event of RRP are (1) reoperate before severe hemodynamic deterioration occurs, (2) plan and conduct the operation to minimize accidents from repeat sternotomy and dissection, (3) keep aortic cross-clamp time as short as possible, and (4) employ cold cardioplegia.
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PMID:Hospital mortality of re-replacement of the aortic valve. Incremental risk factors. 697 1

The authors report on two cases, one of supravalvular aortic aneurysm and one of subvalvular aortic aneurysm. Both patients suffered from bacterial endocarditis of the aortic valve, superimposed on previous rheumatic valvular disease. The authors believe that such aneurysms represent typical though rare complication of bacterial endocarditis of the aortic valve. Subvalvular aneurysms should be the consequence of the systolic stress acting on the myocardial wall involved by endocarditis, whereas supravalvular aneurysms could result from the jet-lesion through the affected valve.
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PMID:[Aortic aneurysms as complication of bacterial endocarditis. Report of two cases (author's transl)]. 732 29

During the past 2.5 years, 50 Ross operations have been performed at Rigshospitalet in Copenhagen in a broad range of patients with aortic valve disease including children and adults from 6 weeks to 71 years of age. Many patients had complicating conditions including endocarditis (n = 13, eight native, five prosthetic valve), prosthetic valve dysfunction (n = 4), subvalvular obstruction (n = 3) treated by septal myectomy (n = 1) or modified Konno operation (n = 2), ascending aortic aneurysm (n = 2), ventricular septum defect (n = 1), mitral valve disease (n = 6), rheumatic heart disease (n = 4), coronary artery disease (n = 1), and extreme obesity (n = 1). All operations were performed as free-standing total aortic root replacements. The results have been encouraging with low mortality (2%) and no major morbidity. One patient has been reoperated because of autograft insufficiency due to left coronary cusp prolapse and two additional patients have grade 2 autograft insufficiency and are being followed closely. Two patients have developed early pulmonary homograft stenosis, which has required pulmonary homograft replacement. Despite these problems, we are enthusiastic about this operation and believe it may emerge as operation of choice for most patients under 60-65 years of age with aortic valve disease and for patients with prosthetic or advanced native aortic valve endocarditis. With increasing frequency, our choice has been to proceed with a Ross operation, and currently, our only absolute contraindication is Marfan's syndrome. Based on reported recurrent disease in patients with rheumatic valve disease, the autograft should be used with caution for this indication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Expanding indications for the Ross operation. 758 41

This is a report of early clinical experience with an autologous tissue cardiac valve, which demonstrates the feasibility of making a bioprosthesis in the operating room in 10 minutes at the time of the valve replacement operation. There were 30 implant patients (18 men, 12 women), with ages ranging from 32 to 83 years. Diagnoses included calcified aortic stenosis (n = 16), pure aortic insufficiency (n = 9), and mixed aortic stenosis and insufficiency (n = 5). Associated diagnoses have included chronic renal failure treated with dialysis (n = 1), coronary artery disease requiring concomitant coronary bypass (n = 1), ascending aortic aneurysm requiring resection (n = 3), and mitral insufficiency requiring concomitant mitral valvuloplasty (n = 2). All of the valve replacements were in the aortic position. These implanted patients are being followed up carefully according to the protocol that requires examination every 6 months for the first year and every 12 months subsequently. No patient has been lost to follow-up. Twenty-seven patients are alive and well from 1 to 22 months postoperatively. There were three deaths: two perioperative deaths (one perivalvular leak and one hemorrhage) and one infective endocarditis 1.3 years after valve replacement. All surviving patients were followed up by echocardiographic examination (mean gradient, 15.5 +/- 6.8 mm Hg at 1 year). In conclusion, the feasibility of this method and concept has been demonstrated with implants in 30 patients. The validity of the technique will be judged by clinical results and experiences in children.
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PMID:The autologous tissue cardiac valve: a new paradigm for heart valve replacement. 764 57

The Hancock II bioprosthesis was used for heart valve replacement in 843 patients from 1982 to 1993. Aortic valve replacement (AVR) was performed in 536 patients, mitral valve replacement (MVR) in 250, and aortic and mitral valve replacement (DVR) in 57. The mean age was 64 +/- 12 years. Before operation, 80% of the patients were in New York Heart Association functional class III or IV; approximately one-third of the patients had coronary artery disease, and 60 patients had ascending aorta aneurysm. There were 47 operative deaths (AVR, 4%; MVR, 7%; DVR, 10%) and 147 late deaths. Follow-up was complete in 98.6% of the patients and extended from 3 to 140 months (mean, 59 months). At the last follow-up, 84% of the patients were in New York Heart Association class I or II. The actuarial survival at 10 years was 63% +/- 4% for AVR, 55% +/- 5% for MVR, and 53% +/- 9% for DVR. At the end of 10 years, the freedom from thromboembolic complications was 80% +/- 4% for AVR, 88% +/- 3% for MVR, and 86% +/- 5% for DVR; the freedom from endocarditis was 95% +/- 2% for AVR, 96% +/- 1% for MVR, and 87% +/- 5% for DVR; the freedom from primary tissue failure was 92% +/- 3% for AVR, 81% +/- 6% for MVR, and 65% +/- 16% for DVR; and the freedom from reoperation was 89% +/- 2% for AVR, 81% +/- 6% for MVR, and 61% +/- 15% for DVR. The durability of this bioprosthetic valve was affected by the patient's age and by the position where it was implanted. The clinical results of the Hancock II bioprosthesis at 10 years are comparable to those of other current porcine and pericardial valves.
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PMID:The Hancock II bioprosthesis at ten years. 764 64

One hundred fifty consecutive Marfan patients undergoing composite graft repair of an ascending aorta aneurysm are reported. Twenty-six of the 150 patients had a preoperative dissection of the ascending aorta. There were no early deaths among 138 patients undergoing elective composite graft repair. There was one early death among 12 patients undergoing urgent operation; this patient arrived at the hospital with a rupturing aneurysm. Twenty-four of the 150 patients had mitral procedures; there were no early deaths in this group. There have been 14 late deaths among the 149 hospital survivors (9%). Actuarial survival of 150 patients at 1, 5, 10, and 14 years was 93%, 92%, 81%, and 73% respectively. Risk factors for early or late death were identified by multivariate analysis and only New York Heart Association class (III or IV) and male gender emerged as significant independent predictors of mortality. Late complications directly related to the composite graft have been gratifyingly low; only 2 patients had coronary dehiscence and 3 had thromboembolic events. Endocarditis emerged as an important late complication in 8 patients (5%). Two patients were successfully treated with antibiotics, 3 died before widespread availability of cryopreserved homografts, and 3 patients treated with antibiotics and homograft root replacement have had no evidence of recurrent infection. Seven patients with dissection in this series had aortic diameters of 6.5 cm or less. This experience supports the concept that composite graft repair in Marfan patients is mandated when the aneurysm reaches 5.5 to 6 cm, even in the asymptomatic patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Composite graft repair of Marfan aneurysm of the ascending aorta: results in 150 patients. 799 90

Available information on atherosclerosis of thoracic aorta in man is scanty and mostly derived from pathological or surgical series. Transesophageal echocardiography makes a clear definition of the entire thoracic aorta possible and enables large, population based studies. In order to define prevalence, risk factors and clinical implications of aortic atherosclerosis, the echocardiographic recordings of 220 patients suitable for both evaluation of thoracic aorta and risk factors analysis were reviewed. Transesophageal echocardiography has been performed because of valvular diseases (78), suspected aortic aneurysm or trauma (43), evaluation of valve prosthesis (39), previous cerebral or peripheral embolic events (22), infective endocarditis (14), cardiac mass lesions (12) or other indications (12). Age ranged from 5 to 81 years (55 +/- 15), male to female ratio was 0.99. Simple and complex atherosclerotic plaques were identified in 33% and 10% respectively. Complex atheromas were more frequent among patients with previous embolic episodes (6/22, 27% versus 17/198, 8.5%; p = 0.019). The prevalence of any type of atherosclerosis progressively increased from the fourth (8%) to the eighth (88%) decade of age. By univariate analysis age (p < 0.001), history of hypertension (p < 0.001), systolic (p < 0.001) and diastolic (p < 0.05) pressure, type II diabetes mellitus (p < 0.01), HDL cholesterol (p < 0.01), HDL/total cholesterol (p < 0.01) and uricaemia (p < 0.05) were associated with aortic atherosclerosis. Discriminant analysis identified 5 independent variables associated with the presence and the extent of atherosclerosis (Wilk's Lambda = 0.43): number of cigarettes per day, age, history of hypertension, systolic pressure and type II diabetes mellitus. This model provided a 63% correct classification rate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The prevalence, risk factors and clinical significance of atherosclerosis of the thoracic aorta: a transesophageal echocardiographic study]. 822 39


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