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

A total of 63 patients, who survived mitral valve replacement with the Kay--Shiley caged disc mitral valve prosthesis, were followed for 11 years by single clinic group to assess long-term results post valve replacement. Sixty-one patients (97%) received a muscle guard type Kay--Shiley prosthesis. All patients received oral anticoagulation therapy. The valvular damage was caused by rheumatic disease in 51 patients, infectious endocarditis in six patients, myxomatous degeneration in two patients, coronary artery disease in two patients, and idiopathic ruptured chordae tendineae in two patients. Late death occurred in 21 patients (33%); the 10-year actuarial survival was 65%. Twenty-six patients had at least one thromboembolic event, and the total number of thromboembolic events was 10.3 per 1000 patient months. Two patients developed prosthetic valve endocarditis. Both patients were heroin addicts and died of valve ring abscess. Long-term periods of clinical observation are necessary to assess the effects and benefits of prosthetic valve implantation. These data are important for comparison with other "10-years" valves.
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PMID:Clinical experience with the Kay-Shiley mitral valve prosthesis: an eleven-year follow-up study. 722 98

Between May, 1975, and May, 1979, 184 glutaraldehyde-preserved valve bioprostheses were implanted (92 aortic, 76 mitral, and 16 multiple). In the last two years, anticoagulants have been administered for the first three post-operative months. Of 176 patients, 10 patients had simultaneous coronary surgery, and five had previous valve surgery; endocarditis had occurred in eight patients before operation, and heart block existed in four patients. In the group of patients who underwent aortic valve replacements, there were four early deaths, all in patients with associated severe coronary artery disease. There was one late death in this group caused by bacterial endocarditis. In the group with mitral valve replacements, there were three early deaths, one related to massive thrombosis of the prosthesis, and two late deaths of unknown cause. Within the whole group, there were seven instances of significant thromboembolism, and nine instances of incompetence, including five mitral periprosthetic leaks which required reoperation. Three patients had stenosis of the mitral prosthesis. There has been no known incidence of intrinsic leaflet incompetence.
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PMID:Complications with glutaraldehyde-preseved bioprostheses. 739 38

The results of preoperative echocardiography were compared with the pathologic findings at the time of surgery in 24 patients undergoing valve surgery for endocarditis. Of the 32 valves involved by vegetations, 27 (84%) were identified preoperatively. Valve destruction was correctly predicted in 16 of 18 cases. Myocardial abscess formation was detected in only one of the five patients in whom it occurred. Overall, the echocardiograms satisfactorily predicted the pathologic anatomy in 20 cases. In the remaining four patients, the echocardiographic description was seriously incomplete or misleading. Thus, surgery can be recommended on the basis of the clinical and echocardiograhic findings for patients with endocarditis. Cardiac catheterization is reserved for patients in whom significant coronary artery disease or intracardiac shunts are suspected or in whom a satisfactory echocardiogram cannot be obtained.
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PMID:Echocardiographic and surgical correlations in bacterial endocarditis. 739 91

We reviewed 56 cases of infective endocarditis (IE) in patients 65 years of age and older. The clinical features, laboratory manifestations, and bacterial etiology of IE in our patients were similar to those in younger patients. Ninety-three percent were febrile, 86% had heart murmurs, and 36% had peripheral stigmas. Streptococci were predominant in community-acquired cases and staphylococci in nosocomial infections; most patients (89%) had persistent bacteremia. Preexisting valvulitis was present in only 23% of patients; 34% had evidence of atherosclerotic heart disease. Complications included congestive heart failure (CHF) in 64%, neurologic sequelae in 36%, and myocardial infarction in 13%. The mortality rate was 45%. A significantly increased mortality was associated with neurologic sequelae, myocardial infarction, or IE with Staphylococcus aureus. The diagnosis of IE should be considered in any elderly patient with a fever, heart murmur, worsening CHF, or an acute cerebrovascular insult.
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PMID:Infective endocarditis in the elderly. 743 45

Three hundred eighty-seven pregnancies (295 patients) complicated by maternal heart disease, managed at the National Maternity Hospital, Dublin, Ireland, during the years 1969 to 1978, were reviewed. The incidence was 0.5%. Three hundred twenty-three (83.5%) were of rheumatic origin, 52 (13.4%) were congenital, and the remaining 12 (3.1%) were a miscellaneous group and included cases of cor pulmonale and coronary artery disease. There were two maternal deaths--one from congenital heart disease and one from postpartum suicide, unrelated to mild rheumatic heart disease. The perinatal mortality rate was 3.3%. Five pregnancies (three patients) were complicated by surgically uncorrected cyanotic congenital heart disease. One of the maternal deaths and three of the perinatal deaths occurred in this group. There were 38 episodes of cardiac failure (38 patients) in cases of rheumatic heart disease. The New York Heart Association grading was grade 1 in 15 (39%) of these before the onset of failure. Prophylactic antibiotics were not used and infective endocarditis did not occur. Therapeutic abortion was not practiced and a conservative approach was adopted in obstetric intervention and in all drug therapy.
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PMID:Pregnancy complicated by maternal heart disease at the National Maternity Hospital, Dublin, Ireland, 1969 to 1978. 745 8

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

We have proposed Rasping procedure as one of the methods of aortic valvuloplasty (A-Rasping) and defined as debridement of the thickened surface of the rheumato-degenerative aortic valve using an electric rasper since 1986. Furthermore, we have extended this technique to mitral valvuloplasty (M-Rasping). The purpose of this study is to evaluate intermediate to late results of valvuloplasty by Rasping procedure. From 1986 to 1994, this method was carried out on 14 patients with mild-to-moderate aortic valve disease in severe mitral valve disease or coronary artery disease, and on 6 patients with mitral stenosis. In A-Rasping group, aortic regurgitation was found in 10 patients and aortic stenosis was found in 4 patients. The degree of regurgitation, the transvalvular pressure gradient, and the pre- and postoperative cardiac function in both group were investigated chronologically by echocardiography. In this series of patients, no hospital mortally including operative death was observed. Furthermore, reoperation for repaired aortic or mital valve was not required. In A-Rasping group, 2 late deaths (14.2%) occurred at 1 year and 4 years after operation. Cause of 2 late deaths was prosthetic valve endocarditis in mitral position. In A-Rasping group, at 1 year after operation, regurgitation was reduced to degree I or less in all patients. However, at the 3rd postoperative year, regurgitation increased to degree II in 2 patients. As compared with the preoperative values, the transvalvular pressure gradient significantly decreased in 4 patients (29.5 +/- 7.6 mmHg vs 12.5 +/- 5.0 mmHg, p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Intermediate to late results of aortic or mitral valvuloplasty by rasping procedure]. 761 24

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

A stentless porcine aortic valve was used for aortic valve replacement in 123 patients from 1987 to 1993. The mean age of 86 men and 37 women was 61 +/- 12 years. Most patients had aortic stenosis; one-third had coronary artery disease and six had mitral valve disease. The stentless valve was secured in the subcoronary position by the same technique used for a freehand aortic valve homograft. The size of valve was based largely on the diameter of the sinotubular junction of the aortic root. The mean valve size was 26.5 mm (range 19 to 29 mm) and 87% were 25 mm or larger. Two operative deaths occurred, one the result of myocardial infarction and the other the result of infective endocarditis. Patients have been followed up from 3 to 77 months, mean 22 months. Three late deaths, none related to the valve, have occurred. The actuarial survival at 6 years was 91% +/- 4%. Four transient cerebral ischemic events have occurred, but two patients had extracranial cerebrovascular disease. One patient had endocarditis late in the postoperative period and required reoperation. All patients had Doppler echocardiographic studies before discharge from the hospital, 3 to 6 months later and annually. Only 15 patients have aortic insufficiency, trivial in 6 and mild in 9. The peak and mean systolic gradients decreased significantly during the first 3 to 6 months after implantation (p < 0.001), and the effective valve areas increased significantly during this time interval (p < 0.001). This improvement in valve hemodynamics is believed to be due to remodeling of the aortic root and regression of left ventricular hypertrophy. The results of aortic valve replacement with this stentless bioprosthesis have been excellent and justify its continued use in older patients.
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PMID:Aortic valve replacement with a stentless porcine aortic valve. A six-year experience. 798 72


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