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

Brucella abortus infection of the aortic valve caused acute aortic regurgitation leading to severe left ventricular failure in a 62-year-old man. He made an excellent recovery after emergency aortic valve replacement. This is the third reported case of successful heart valve replacement for Brucella endocarditis and the second such case involving the aortic valve.
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PMID:Destructive aortic valve endocarditis from Brucella abortus: survival with emergency aortic valve replacement. 10 38

A 64-year-old man, who underwent double valve replacement for mitral and aortic incompetence due to infective endocarditis, presented with a coronary embolism of a fragment of mitral papillary muscle in the immediate post-operative period. The diagnosis, suggested by the sudden development of acute myocardial insufficiency during ventricular filling, was confirmed by the absence of clinical or electrical improvement during circulatory assistance and by surgical exploration of the left coronary artery. Complete recovery after embolectomy emphasises the value of the association of circulatory assistance and immediate myocardial revascularisation.
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PMID:[Embolism in a fragment of the mitral papillary muscle to the left main coronary artery. A rare complication of valve replacement]. 11 14

Bacterial endocarditis complicating idiopathic hypertrophic subaortic stenosis (IHSS) is uncommon but endocarditis may be the first clinical manifestation of IHSS. In this report of such a case, the aortic and the mitral valves were the sites of the bacterial infection. Many chordae tendineae to the mitral valve were ruptured from the extension of the infectious process. The endothelial lesions, which served as the seat for the bacterial infection on the anterior mitral leaflet, likely resulted from its abutting action against the septal prominence. Damage to the aortic valve leaflet may have resulted from abnormal valve motion caused by IHSS and created an environment conducive to endocarditis. This patient developed aortic insufficiency during the course of bacterial endocarditis, suggesting that the occasional association of aortic insufficiency in patients with IHSS may be secondary to healed endocarditis of the aortic valve.
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PMID:Bacterial endocarditis in idiopathic hypertrophic subaortic stenosis. 12 16

The data were reviewed of 42 patients who had valvulotomy for severe aortic valve stenosis before 1968. All were over age 2 years (mean age 11.3 years). The mean time of follow-up after surgery was 10.6 years (range 6 to 16.3 years). No patient died at operation. Two late deaths were from endocarditis with aortic regurgitation, and one patient with severe arotic regurgitation died suddenly; three patients had valve replacement for aortic regurgitation and one required repeat valvulotomy. Five patients could not be traced. Major symptoms were alleviated in all patients. Left ventricular pressures were obtained in 15 patients before and after operation; the mean gradient averaged 100 mm Hg before and 43 mm Hg after operation. No patient had significant aortic regurgitation before operation. Twelve had moderate to severe regurgitation after operation. The incidence of late valve calcification at a mean time of 10.6 years after operation was small, and restenosis was uncommon. Because moderate or severe incompetence can be produced and stenosis is often incompletely relieved, the operation is palliative, but the low morbidity and mortality rates suggest that it is an effective procedure if stenosis is severe and life-threatening.
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PMID:Long-term follow-up of valvulotomy for congenital aortic stenosis. 13 6

This report documents the clinicopathologic correlation between pure aortic regurgitation and an exceptional form of congenitally bicuspid aortic valve. The patient was known for many years to have mild aortic insufficiency. His condition suddenly deteriorated, with signs of an aggravated aortic regurgitation. Infectious endocarditis was considered, but the diagnosis was never established. Surgery revealed an exceptional form of a bicuspid aortic valve in which the conjoined cusp had prolapsed, due to rupture of a fibrous strand which previously had anchored the free rim of the cusp to the inner wall of the aorta. There were no signs of infectious endocarditis. It is suggested that spontaneous rupture of the cord caused the sudden aggravation of aortic regurgitation.
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PMID:Spontaneous rupture of bicuspid aortic valve. An unusual cause of aortic insufficiency. 14 17

Endocarditis involving a prosthetic aortic valve is associated with persistently positive blood cultures and aortic regurgitation. With rare exception, it is a fatal disease. An experimental technique was developed that would allow for removal of the infected aortic prosthesis with debridement and permanent closure of the aortic root. An extraanatomical outflow for the left ventricle was created using a valve-containing conduit between the apex of the left ventricle and the descending thoracic aorta (apicoaortic anastomosis). The procedure was performed on 5 mongrel dogs through a left thoracotomy without use of cardiopulmonary bypass. Four survived the procedure and required no cardiotonic support. One died as a result of a technical problem. Intraoperative pressure determination revealed a 0 to 15 mm Hg gradient across the apioaortic prosthesis and a left ventricular end-diastolic pressure of 0 to 4 mm Hg. Both postoperative angiocardiogram and postmortem examination confirmed patency of the aortocoronary bypass grafts and good function of the prosthesis.
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PMID:Extraanatomical bypass of the aortic root: an experimental technique. 30 3

Knowledge and due consideration of the natural history of valvular heart disease are prerequisites for their operative therapy. Presumptive mortality and morbidity of the surgical intervention must be weighted against the expected prognosis under medical treatment alone. The timing of the operation depends on these considerations. Mitral stenosis and the chronic forms of mitral and aortic incompetence have similar natural histories and for both signs and symptoms are good indicators for an eventual progression of the condition. The length of the period during which the patient is free of complaints may be quite variable but a critical change in the natural history comes about once the disease causes signs and symptoms. Surgical repair is indicated when the patient reaches stage III according to the NYHA-classification. The prognosis is worst for aortic stenosis, in particular due to the danger of sudden death. Patients with high pressure gradients are at particularly high risk; this holds even true for those patients which are not yet suffering from any complaints. The prognosis becomes even more serious, when signs such as dyspnea, anginal pain, or syncopal attacks occur. Prognosis and indication for surgical intervention cannot be evaluated reliably by considering only the clinical signs without knowledge of hemodynamic parameters. Acute mitral and aortic incompetence, in paricular when they occur during baterial endocarditis, must be observed very closely because of their most serious prognosis; if necessary, emergency surgery must be carried out in these cases.
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PMID:[Natural history in patients with mitral- and aorticvalve-disease (author's transl)]. 32 60

Acute severe aortic regurgitation is a relatively unfamiliar, though life-threatening, disease. We review its diverse causes, anatomic faults, and hemodynamic sequelae and set the stage for an understanding of the clinical manifestations in light of their physiologic mechanisms. Clinical information includes the natural history, physical signs (physical appearance, systemic arterial pulse, jugular venous pulse, precordial palpation, auscultation), electrocardiogram, and chest roentgenogram. Echocardiographic features are especially emphasized and the need for prompt diagnosis and surgical intervention underscored, even in the setting of active infective endocarditis.
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PMID:Acute severe aortic regurgitation. Pathophysiology, clinical recognition, and management. 32 30

Our patient, with cirrhosis and chronic renal failure, represents an example of the susceptibility of a compromised host to Aeromonas infections. This patient, however, differs from previously reported cases in at least two important aspects. First, it is possible that her portal of entry was a fresh A-V fistula puncture site rather than an intestinal site. The temporal relationship of exposure to flood water prior to the onset of sepsis lends support to this possibility. Epidemiologic investigation of the dialysis center failed to reveal Aeromonas isolates from cultures of the water supply, machinery, or other patients. Second, this case is unique in that our patient developed a destructive aortic valve endocarditis resulting in valvular perforations and acute aortic insufficiency. Furthermore, this infection was initiated on what appears to have been a previously normal valve. Based on a review of the literature and the virulence demonstrated by A. hydrophila in our patient, we conclude that organisms of the genus Aeromonas are capable of inducing serious human infection. Such infections are more likely to occur in compromised hosts. A. hydrophila has accounted for the majority of reported infections.
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PMID:Human aeromonas infections: a review of the literature and a case report of endocarditis. 34 23

Clinical applications involve heart failure during the acute phase of myocardial infarction, with the possibility of reducing the degree and extent of the perinecrotic ischaemic zone of the infarction. Treatment of this type would seem also to be particularly valuable in the provisional management of acute or sub-acute regurgitating valvular lesions: mitral insufficiency and interventricular communication secondary to an acute infarction, mitral and/or aortic regurgitation due the endocarditis. Finally, the results of oral vasodilators in the context of chronic refractory heart failure would seem ot be encouraging in the short term but their influence on long term prognosis is not known.
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PMID:[The treatment of cardiac insufficiency using vasodilators (author's transl)]. 35 54


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