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

Prevention of infective endocarditis continues to concern health care providers in many specialties. The well-known lack of primary clinical trials in this area is not expected to change. Therefore, the evolution of recommendations and practice must be based on theoretic considerations and continuing assessment of secondary sources of information. Recent developments include a report of 52 cases in which antibiotic prophylaxis for infective endocarditis was attempted but appeared to fail. Most of these patients had undergone dental procedures after oral penicillin prophylaxis, with subsequent development of streptococcal endocarditis. In two thirds, the organism was sensitive to the antibiotic used. Notably, the most common underlying cardiac lesion among these patients was mitral valve prolapse. However, two recent independent analyses have concluded that providing endocarditis prophylaxis for all patients with mitral valve prolapse during procedures that might cause bacteremia would not be cost-effective. This is primarily because mitral valve prolapse is common and endocarditis is relatively rare, resulting in an adverse risk-benefit ratio. Parenteral prophylaxis for mitral valve prolapse might even cause a net loss of life from anaphylaxis. On the other hand, for the individual patient or physician, the reassurance provided by attempted prophylaxis with oral penicillin can be purchased at low cost and low risk. Very few cases of infective endocarditis have been reported after gastrointestinal and other endoscopic procedures; most of these do not need antibiotic coverage. Prophylactic antibiotics should be restricted to those situations in which both the procedure and the underlying cardiac condition seem to pose significant risk, for example, endoscopic sclerotherapy of esophageal varices in patients with prosthetic heart valves. Newly revised recommendations have been issued by the Medical Letter, the American Heart Association, and the American Dental Association. These regimens are shorter and simpler than earlier versions.
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PMID:Current issues in prevention of infective endocarditis. 401 77

Situations which can be considered at risk for infective endocarditis are those causing a bacteremia, which is necessary for the development of an endocarditis. Such situations can be identified by clinical studies evaluating the rate at which a bacteremia occurs after some procedures or because of lesions, then the risk of endocarditis after such a bacteremia. Without considering preexisting cardiac lesion and age, some situations seem to be at risk of subsequent endocarditis: acute bacterial infection for which antibiotherapy is necessary; procedures involving the mouth with the exception of superficial caries and bloodless supragingival prosthetic preparations; oesophageal dilatation, laser endo-oesophageal procedures, sclerosis of oesophageal varices; colonoscopy and sigmoidoscopy for cancer lesions, gastrointestinal procedures on a potentially infected gastrointestinal tract (cholecystectomy, colectomy...); tonsillectomy and adenoidectomy; naso-tracheal intubation; instrumental procedures involving the ureter or kidney, and prostatic or urinary tract biopsies and surgery; procedures performed on infected skin. In cardiac patients at high risk, in addition to the above retrograde cholangiography, colonoscopy and rectosigmoidoscopy, lithotripsy. In these situations the risk of endocarditis is probably linked to the rate of bacteremia, the size of inoculum, and the bacteria, compared with spontaneous bacteremia without any procedure, where the inoculum is low and bacteria is considered as non pathogenic. A prophylaxis has to be discussed in such situations, which are probably involved in less than 10% of endocarditis.
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PMID:[Situations and procedures with risk of bacterial endocarditis (intracardiac surgery excluded)]. 802 96

To describe the role of transesophageal echocardiography (TEE) in the diagnosis of various cardiac pathologic conditions, we reviewed the currently accepted clinical applications, the contraindications to the procedure, and the potential complications. The Mayo Clinic experience with 7,134 TEE examinations during a 6-year period (1988 through 1993) was summarized, and TEE results reported in the literature were reviewed. TEE has a substantially higher yield than transthoracic echocardiography (TTE) for diagnosis of direct and indirect sources of cardioembolism. Moreover, TEE is highly sensitive for detecting abnormalities of mitral prostheses and endocarditis-related complications of aortic prostheses. TEE is superior to TTE for localization and characterization of cardiac and paracardiac masses. In addition to establishing the diagnosis of aortic dissection, TEE can readily show the site, type, and extent of the tear. Ventilated, critically ill patients can safely undergo TEE. TEE has a limited role in the assessment of neonates, infants, and children with congenital heart disease because TTE can provide almost all the necessary information in such patients. Intraoperatively, TEE is useful for managing patients undergoing mitral valve repair and for monitoring for air and fat embolism in those undergoing neurosurgical procedures or hip replacement. Absolute contraindications to the performance of TEE include a history of dysphagia, current pathologic conditions of the esophagus, and recent esophageal operations. In patients with relative contraindications, such as esophageal varices or active upper gastrointestinal bleeding, the risk-to-benefit ratio must be assessed before TEE is performed. Complications associated with TEE can be related to the probe, to the procedure, or to drugs used during the examination.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Transesophageal echocardiography. 780 45

Splenic arterial aneurysms (SAA) are rare and are usually atherosclerotic and/or related to pregnancy. Because pregnancy is the most important predisposing factor, the strong predilection of SAA for women is not surprising. The authors report a case of SAA rupture in a man with chronic pancreatitis as the predisposing factor. A 56-year-old man with abdominal pain and hematemesis was resuscitated and underwent endoscopy, but he died 18 hours later of massive hematemesis before definitive surgery could be carried out. At autopsy, there was chronic pancreatitis with fibrous adhesions tethering the tail of the pancreas, spleen, and posterior wall of the stomach together. The SAA was indented into the posterior wall of the stomach, into which it had ruptured from without. He also had alcoholic cirrhosis but no esophageal varices or conventional gastric ulcers. Other important predisposing factors such as abdominal trauma, infective endocarditis, polyarteritis nodosa, and segmental medial arteriopathy were absent. Histologic examination confirmed the rupture of the SAA. The SAA had Monckeberg medial calcinosis but little evidence of atherosclerosis. The well-documented complications of acute and chronic pancreatitis include shock, abscess, pseudocyst formation, and duodenal obstruction. This report describes the rare complication of SAA rupture, which may be fatal.
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PMID:Fatal splenic arterial aneurysmal rupture associated with chronic pancreatitis. 1219 58

A 73-year-old man with history of coronary artery disease and bypass surgery, atrial fibrillation, and left lower lobe non-small cell lung cancer was admitted with recurrent pneumonia and was referred for transesophageal echocardiogram for suspected aortic valve endocarditis by transthoracic echocardiography. The patient had a history of radiation treatment for lung cancer 6 years ago. He had subsequently developed esophageal strictures requiring repeated dilatations, and eventually repeated esophageal stenting. Recurrent aspiration pneumonia led to the discovery of stent erosion into his trachea leading to tracheoesophageal fistula. A covered Y tracheal stent was placed to close the fistulous tract, but persistent aspiration was noted. The cross-sectional diameter of the esophageal stents was determined to be larger than the transesophageal echocardiography (TEE) probe. TEE was performed under fluoroscopy for added safety. The esophageal stent position was confirmed with fluoroscopy before and after the procedure and the TEE probe remained inside the distal stent in the midesophageal position during the entire procedure. Small mobile vegetation was seen on the right coronary cusp and the noncoronary cusp showed a smaller vegetation. The patient tolerated the procedure well and there were no complications. Infectious disease consultation was obtained and antibiotic regimen was modified accordingly. Although there are studies addressing the safety of TEE in patients with esophageal varices, to our knowledge, there is no report of TEE being performed in patients with esophageal or tracheoesophageal stents. This case illustrates that TEE may be performed in patients with esophageal stents under careful fluoroscopic guidance. (Echocardiography 2012;29:E5-E7).
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PMID:Fluoroscopically guided transesophageal echocardiogram in a patient with esophageal stents. 2198 95

Only 75% of severe tricuspid regurgitation is classified as functional, or related primarily to pulmonary hypertension, right ventricular dysfunction, or a combination of both. Non-functional tricuspid regurgitation occurs when there is damage to the tricuspid leaflets, chordae, papillary muscles, or annulus, independent of right ventricular dysfunction or pulmonary hypertension. The entities that cause non-functional tricuspid regurgitation include rheumatic and myxomatous disease, acquired and genetic connective tissue disorders, endocarditis, sarcoid, pacing, RV biopsy, blunt trauma, radiation, carcinoid, ergot alkaloids, dopamine agonists, fenfluramine, cardiac tumors, atrial fibrillation, and congenital malformations. Over time, severe tricuspid regurgitation that is initially non-functional, can blend into functional tricuspid regurgitation, related to progressive right ventricular dysfunction. Symptoms and signs, including a falling right ventricular ejection fraction, cardiac cirrhosis, ascites, esophageal varices, and anasarca, may occur insidiously and late, but are associated with substantial morbidity and mortality. Attempted valve repair or replacement at late stages carries a high mortality. Crucial to following patients with severe non-functional tricuspid regurgitation is attention to echo quantification of the tricuspid regurgitation and right ventricular function, patient symptoms, and the physical examination.
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PMID:Non-functional tricuspid valve disease. 2870 63