Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0014118 (endocarditis)
 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The superior performance of stentless aortic valves with improved left ventricular hypertrophy regression and greater effective orifice area is proven. The Aortech Elan stentless valve (AESV) is a glutraldehyde preserved porcine valve with a pericardial reinforced inflow tract and a scalloped outflow to reduce bulk. We present the early results of AESV implantation at our institution. The first 41 consecutive recipients of the AESV at our unit, between November 1999 and December 2000, were studied. Mean preoperative New York Heart Association functional class (NYHA) status was 3.00 +/- 0.1. Patients requiring a bioprosthesis with suitable anatomy routinely received this implant. The AESV was implanted, either with an interrupted or continuous suture to the inflow tract and a continuous suture to the outflow tract. Transthoracic echocardiography was performed at 6 to 9 weeks after surgery, and aortic transvalvular gradients, flow velocities, and effective orifice areas (EOA) were calculated. In the early postoperative period, two patients with coronary artery disease died of low cardiac output. Echocardiography demonstrated competent valves. At follow-up, one patient was shown to have mild to moderate perivalvular leak with minimal symptoms. Two patients with aortic regurgitation secondary to bacterial endocarditis had no evidence of infection at 3 months after surgery. Mean transvalvular gradient was 6.91 +/- 0.87 mm Hg and mean effective orifice area was 1.18 +/- 0.04 cm(2)/m(2) at a mean of 8.4 weeks after surgery. AESV recipients for native aortic endocarditis were free from infection and regurgitation. The Elan stentless aortic valve demonstrates excellent early hemodynamic results, with very low transvalvular gradients, good flow characteristics and low regurgitation incidence. Ease of implantation is evidenced by favorable ischemic times. This valve may offer an option to homograft in acute aortic endocarditis. Long-term results are awaited.
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PMID:The aortic Elan stentless aortic valve: excellent hemodynamics and ease of implantation. 1180 49

Stentless valves in the aortic position have been shown to have superior hemodynamic performance to stented valves and have now been shown to increase survival. We report the medium-term results from a single center of 229 Toronto (SPV) aortic valve replacements between 1994 and 2000. The mean age of the patients was 72 years (range, 41-87 years). The mean Euroscores were 6.2 (+/-0.13) and Parsonnet scores of 16.8 (+/-0.5). Concomitant coronary artery bypass grafting was performed in 125 (55%) of patients, eight patients had additional mitral valve replacements and ten were redo procedures. Hospital mortality was 3.5%. The mean follow-up period was 45 (7-81) months. The actuarial survival was 92.4% (+/-1.4%) at one year and 76.2% (+/-3.5%) at five years. There were 37 late deaths (4.7% per patient years). There were 3 patients with prosthetic valve endocarditis (0.38% per patient years), two of whom died. Stroke occurred in 13 patients (1.6% per patient years), five of whom died. None of these events were known to be valve related. There was no incidence of structural valve dysfunction and no valves have been explanted. At follow-up, the mean transvalvular gradient was 4.2 mm Hg (range, 0.9-12.7 mm Hg). No aortic incompetence (AI) was seen in 88% of patients with trivial or mild AI in 11% of patients and moderate AI in one patient. This series shows acceptable early and medium-term results in an elderly population with a high incidence of coronary artery disease.
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PMID:Six-year follow-up of the Toronto stentless porcine valve. 1180 67

Reoperative surgery for degenerated aortic and mitral valve bioprostheses has a considerable mortality. This study compares life expectancy, mode of failure and predictors for emergency reoperation and reoperative mortality between degenerated aortic and mitral bioprostheses. A total of 265 bioprosthetic valve patients, 172 aortic and 93 mitral patients, were followed to assess the time period between first and redo valve replacement. Mean life expectancy for aortic bioprostheses was 10.4 +/- 4.3 (2 to 28.6) years, whereas it was 10.0 +/- 3.7 (0.9 to 20) years for mitral bioprostheses (group M). Emergency reoperation had to be performed in 31/172 group A (18%) and 16/93 group M (17%) patients. In group A, the reoperative mortality was 5.2%; it was 1.4% for elective and 22.6% for emergency reoperation (p < 0.0001; OR = 20.3). Reoperative mortality in group M patients was 5.4% and did not differ between elective and emergency surgery. Group A patients who died at reoperation had higher transvalvular gradients before the first operation (p = 0.007), received smaller sized bioprostheses (p = 0.03) and had a higher incidence of coronary artery disease (p = 0.001) and pulmonary artery hypertension (p = 0.009) acquired during the interval. Endocarditis being the reason for primary surgery (p = 0.004), postoperative pneumonia after the first procedure (p = 0.005), pulmonary artery hypertension (p = 0.0004), later recurrence of symptoms of valve degeneration (p = 0.04), acute onset of bioprosthetic regurgitation (p = 0.00002) and a lower left ventricular ejection fraction (p = 0.03) were risk factor for emergency surgery. There were no predictors of reoperative mortality identified in mitral valve patients. The life expectancy of aortic and mitral bioprostheses is acceptable even in a relatively young patient population (mean age 46 +/- 13 in group A and 45 +/- 12 years in group M patients). Patients with degenerated aortic bioprostheses undergoing emergency reoperation have an extraordinary high reoperative mortality. They can be identified as patients who had a history of endocarditis and higher transvalvular gradients prior to the first operation, who received smaller sized bioprostheses and acquired coronary artery disease and pulmonary artery hypertension during the interval. Thus, emergency reoperation is preventable, increasing overall life expectancy of patients with bioprostheses. There were no risk factors for reoperative mortality identified in bioprosthetic mitral valve patients.
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PMID:[Timing of reoperation of degenerated aortic and mitral bioprostheses]. 1182 25

A 45 year old male suffered from typical exercise-induced dyspnoea and angina. Crohn's disease treated with glucocorticoids was present for 18 years. Coronary angiography revealed small left anterior descending and right coronary arteries without reference to coronary artery disease, while the main stem and circumflex artery were severely dilated due to a fistula (diameter 5.5 mm) into the coronary sinus with a left/right shunt amounting to 35%. Haemodynamics, significant risk of endocarditis with chronic inflammatory bowel disease and obligatory glucocorticoid treatment were indications for fistula closure. As an alternative to surgical correction, the coronary fistula was totally occluded by antegrade micro-coil embolization. The present report offers a review on differential therapeutic considerations and specific treatment options including novel interventional modalities for coronary fistulas.
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PMID:[Micro-coil embolization of a fistula of the circumflex ramus in the coronary sinus. Case report, differential therapy and review of the literature]. 1200 43

The most common etiologies for mitral regurgitation (MR) include mitral valve prolapse syndrome, coronary artery disease, infective endocarditis, rheumatic heart disease, collagen vascular disease, and, recently, anoretic drugs have also been reported to cause MR. In chronic severe MR, forward cardiac output is maintained for the development of afterload reduction with increase in compensatory left ventricular (LV) end-diastolic volume and LV ejection fraction. It is well established that some patients with asymptomatic mitral regurgitation develop irreversible contractile dysfunction of the LV, which is often masked by the afterload-reducing effect of the regurgitant flow; cardiologist have to use some variables, like LV chamber elastance, LV End-Systolic dimensions and volumes, left atrial area combined with ejection fraction, in their clinical evaluations tube able to predict surgery mortality. Careful and periodic evaluation of left ventricular function and size is essential to optimize the timing of surgical intervention in these patients. After symptoms occur, outcome is improved with surgical interventions compared to medical therapy, with a reported survival of only 45% at 5 years without surgical intervention. Vasodilators, diuretics, and recently, angiotensin receptor antagonists have been used in MR medical therapy. Long-term carvedilol therapy in patients with chronic heart failure may prevent or partially reverse progressive left ventricular dilatation. Concomitant by, it has been associated with recovery of diastolic reserve and a decrease in mitral regurgitation.
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PMID:[Heart failure and pure mitral failure. Prognostic impact and its best treatment]. 1200 70

Coronary-pulmonary fistulas are rare. The majority of these fistulas arise from the left anterior descending or the right coronary arteries; the circumflex coronary artery is rarely involved. The majority of patients are asymptomatic, but heart failure, angina, myocardial infarction, endocarditis, and dyspnea have rarely been reported. The management is controversial and recommendations are based on anecdotal cases or very small retrospective series. A case of a 62-year-old female is reported who presented with chest pain and was found to have myocardial ischemia on SPECT sestamibi. Cardiac catheterization revealed no obstructive coronary artery disease and a large coronary pulmonary fistula communicating from the left circumflex coronary artery to the left pulmonary artery.
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PMID:Myocardial ischemia secondary to a large coronary-pulmonary fistula--a case report. 1202 25

With more effective prophylactic treatment and an increased time of survival, noninfectious conditions associated with human immunodeficiency virus (HIV) disease are being recognized with increasing frequency in HIV patients. Cardiac involvement in HIV-infected patients varies from clinically silent to a fatal disease with a direct cardiac cause of mortality estimated at 1% to 6%. Pericardial effusion, pericarditis, myocarditis, cardiomyopathy, endocarditis, and pulmonary hypertension are known cardiac manifestations associated with HIV infection. Coronary artery disease (CAD) has not been a recognized complication of HIV disease, although some recent case reports have suggested occurrence of premature CAD and accelerated atherogenesis in HIV-infected patients. The role of protease inhibitors have been suggested in the development of this complication. After reviewing records of the last 7 years, the authors found 10 cases of acute coronary syndrome in HIV-infected patients who had no other risk factor for CAD except smoking. The presence of CAD was confirmed by angiography or autopsy. The mean CD4 count was 380 cells/mm3, and the mean duration between the diagnosis of HIV infection and CAD was 7.5 years. Four patients had single-vessel disease, 1 patient had 2-vessel disease, and 5 patients had 3-vessel disease. Three patients underwent coronary bypass surgery and 1 patient died of cardiogenic shock. CAD may be associated with HIV disease.
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PMID:Acute coronary syndrome in patients with human immunodeficiency virus disease. 1236 61

The knowledge regarding the links between dental and cardiac affections are generally based on empirical concepts and lead to unjustified clinical practices. Infectious endocarditis (IE) is the principal cardiac diseases concerned with dental procedures. Although in France, the incidence of IE is stable, the incidence of oral bacteria at the origin of IE is diminishing. The risk of IE and thus the indication of antibioprophylaxis depend upon the subjacent cardiopathy and dental treatment. Antibioprophylaxis has to be very strict in patients with high or moderate risks of IE but is not necessary in low risk patients. In all cases, a good oral and dental hygiene and a regular dentist follow up are the most effective methods of preventing IE. Coronary artery disease and dental affections are associated because they present similar risk factors (i.e. smoking, excessive sugar consumption) and also because inflammation increases the risk of acute coronary syndrome. Today, dental cares are not contraindicated in patients with recent coronary syndrome if precise protocols are followed. Concerning the hemorrhagic risk during dental care in patients treated by anticoagulants and/or antithrombotics, dental cares and extractions are possible if INR or heparinemy are within the therapeutic limits and local haemostasis is meticulous. In addition, aspirin does not require to be stopped before minor dental treatments. Finally a better collaboration between dentists and cardiologists would allow an optimum management of patients with cardiac disease requiring dental cares.
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PMID:[Pathology and dental care in the context of cardiovascular conditions: myths, beliefs and realities]. 1286 45

Infective endocarditis (IE) is one of the most severe complications of parenteral drug abuse. The incidence of IE in intravenous drug abusers (IVDAs) is 2% to 5% per year, being responsible for 5% to 10% of the overall death rate. The prevalence of HIV infection among IVDAs with IE ranges between 30% and 70% in developed countries and HIV-infection by itself increases the risk of IE in IVDAs. The incidence of IE in IVDAs is currently decreasing in some areas, probably due to changes in drug administration habits by addicts to avoid HIV transmission. Overall, Staphylococcus aureus is the most common etiological agent, being usually sensitive to methicillin (MSSA). The tricuspid valve is the most frequently affected (60% to 70%), followed by the mitral and aortic valves (20% to 30%). HIV-positive IVDAs have a higher ratio of right-sided IE and S aureus IE than HIV-negative IVDAs. Response to antibiotic therapy is similar. Drug addicts with non-complicated MSSA right-sided IE can be treated with an i.v. short-course regimen of nafcillin or cloxacillin for 2 weeks, with or without addition of an aminoglycoside during the first 3 to 7 days. The prognosis of right-sided endocarditis is generally good; overall mortality is less than 5%, and with surgery is less than 2%. In contrast, the prognosis of left-sided IE is less favorable; mortality is 20% to 30%, and even with surgery is 15% to 25%. IE caused by GNB or fungi has the worst prognosis. Mortality between HIV-infected or non-HIV-infected IVDAs with IE is similar. However, among HIV-infected IVDAs, mortality is significantly higher in those who are most severely immunosuppressed, with CD4+ cell count < 200/microL or with AIDS criteria. Conversely, IE in HIV-infected patients who are not drug abusers is rare. The epidemiology of cardiac surgery in IVDAs and/or HIV-infected patients has changed in recent years. There is a decrease in IE and an increase of patients undergoing surgery (CABS) for coronary artery disease secondary to the hyperlipidemia and lipodystrophy induced by highly active antiretroviral therapy (HAART). Cardiac surgery in HIV-infected patients with or without IE does not worsen the prognosis because extracorporeal circulation did not affect the immune status after surgery. Morbidity and mortality seems to stay within the same range as the non-infected patients. In our experience, in the IE in HIV-infected IVDA group, the 1-year survival is 65% and the 5 and 10-year actuarial survival is 35%. For patients operated on for coronary artery disease, the 5-year survival is 100%.
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PMID:Infective endocarditis and cardiac surgery in intravenous drug abusers and HIV-1 infected patients. 1287 91

Certain medical conditions and their accompanying drug treatment do have an impact upon oral structures and the delivery of dental care. Recent evidence suggests that oral health could be a significant risk factor for coronary artery disease. Many medical conditions can affect dental care are often over-stated and lack an evidence base. Examples include the need for antibiotic cover in patients at risk from infective endocarditis and the necessity to provide supplementary corticosteroids for those patients on longterm steroid therapy. By contrast, certain systematic drug treatments can have a profound affect on the oral tissue. The most obvious is drug-induced gingival overgrowth. Drugs frequently implicated in this unwanted effect include phenytoin, ciclosporin and the calcium channel blockers. Several risk factors for drug-induced overgrowth have been identified and include age, sex, peridontal variables and a range of drug pharmacokinetic variables. The relationship between oral health and coronary artery disease opens up a potentially new vista for the delivery of oral care. Although the association is convincing, casualty has not been established. If casualty for this relationship can be confirmed then the delivery of dental care and the promotion of oral health will receive a significant impetus.
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PMID:Dentistry and the medically compromised patient. 1557 Jul 64


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