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

This is a multivariate analysis of patients treated with native valve endocarditis at Stanford University. The analysis indicates that the preoperative cardiovascular condition and other organ system functions are important determinants of postoperative outcome in conjunction with the pathology denoted at the time of operation, particularly annular abscess. These two negative factors suggest more intense scrutiny of patients preoperatively and a more aggressive approach to surgery before these two extremely adverse prognostic factors occur. Prevention of native valve endocarditis will also be a major key to overall improvement in the future for prophylaxis of dental hygiene and other minor surgery, particularly in patients with known valvular heart disease.
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PMID:Determinants of outcome in surgically treated patients with native valve endocarditis (NVE). 252 15

St. Jude Medical valve replacement was performed in 1,039 patients; 320 had aortic (AVR), 543 mitral (MVR), and 176 had double valve replacement (DVR). There were 44(4.2%) early deaths. Follow-up extended in 995 patients from 10 to 130 months, with a cumulative period of 2,730 patients-years. The overall survival rates of AVR, MVR, and DVR patients at 10 years were 60.5%, 89.6%, 90.3% respectively. The linearized incidences of valve thrombosis, thromboembolism, anticoagulation-related hemorrhage, prosthetic valve endocarditis, and significant hemolysis were as follows: 0.11%/pt-yr, 1.33%/pt-yr, 0.04%/pt-yr, 0.18%/pt-yr, and 0.11%/pt-yr, respectively. There were no structural failure after 10 years follow-up. Reoperation (explant and re-replacement or suture repair) was required in 10 patients. Seven of them had periprosthetic leakage, 2 had valve thrombosis, and one underwent reoperation because of a technical error. Actuarially over 98% of patients were free of valve-related mortality at 10 years. St. Jude Medical valve is an excellent alternative for use in the surgical treatment of valvular heart disease.
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PMID:[St. Jude Medical valve replacement: clinical experience with 1,039 patients]. 258 55

To evaluate the clinical and microbiological features of infective endocarditis in patients with cirrhosis we compared 18 episodes of endocarditis in these patients with a control group of patients without liver disease. In 61% of patients with cirrhosis the origin of infection was unknown. Four patients developed endocarditis as a consequence of bladder catheterizations and two after hepatic biopsy. None of the four with previously known valvular heart disease had received antibiotic prophylaxis during these procedures. As compared with the control group, the patients with cirrhosis had more infections by enterococci (38.8% vs 11%; p less than 0.007) and non-viridans streptococci (38.8% vs 7.4%; p less than 0.001) and significantly less infections by viridans streptococci (11% vs 42.5%; p less than 0.01). The mortality rate associated with endocarditis was 38.8% and 22% in patients with and without cirrhosis, respectively (less than 0.1; NS). Infective endocarditis in patients with cirrhosis is often a complication of diagnostic or therapeutic procedures and has distinctive microbiological features.
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PMID:[Infectious endocarditis in patients with liver cirrhosis]. 262 60

The clinical, microbiological and echocardiographical features as well as the response to therapy of 19 cases of infective endocarditis (IE) caused by coagulase-negative staphylococci (CNS) are reported. Six patients had native valve IE, 11 had prosthetic valve endocarditis and 2 were associated with catheters in right cardiac chambers. In the group of native valve IE, 11 patients were heroin abusers and 4 had previous valvular disease. IE was left sided in 3 cases, mixed in 2 and right sided in 1. All CNS were methicillin-sensitive. The echocardiogram detected vegetations in 5 of the 6 cases. One patient required surgery and another died. In the group of prosthetic valve IE, 5 patients had early endocarditis and 6 had late endocarditis. A bioprosthesis was involved in 5 cases, a mechanical prosthesis in another 5, and an annuloplasty annulus in one. The involved prosthesis was aortic in 5 cases and mitral in 6. The echocardiogram detected vegetations in 3 cases (27%) and prosthetic dysfunction in 4. One patient had a relapse, 8 (73%) required valve replacement and 3 died. Although the greatest incidence of IE caused by CNS is found among patients with prosthetic valves, it can also be seen in patients with underlying valvular heart disease, drug abusers and patients with indwelling catheters in right cardiac chambers.
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PMID:[Infective endocarditis caused by coagulase-negative staphylococci: a review of 19 cases]. 269 6

The authors have studied the immediate and long term outcome of surgical treatment of acute phase infective endocarditis in a group of 33 high risk patients with valvular heart disease. The age varied from 2 to 68 years, 18 patients were male and 22 were of the white race. The aortic valve was the most frequently involved (18/54.5%), followed by mitral valve (13/39.3%), and tricuspid valve (2/6.0%). Twenty-four patients (72.7%) were in functional class III and seven (21.0%) in functional class IV. The noninvasive studies in those patients revealed 13 cases (39.4%) with normal cardiac size. The EKG was abnormal in 27 cases (81.8%) mostly with left atrial and ventricular hypertrophy. The echocardiogram revealed the presence of vegetations in 27 patients (81.8%) and the blood cultures were positive in 24 cases (72.7%). All patients were treated with antibiotics. The pathologic analysis revealed the presence of vegetations in 94% and structural alterations in 16.5%. Twenty-one patients had heart valve replacement with mechanical prosthesis (63.6%), 11 (33.3%) had bioprosthesis and one had tricuspid excision without replacement (3.0%). The hospital mortality was 12% and the late mortality 3%. Three deaths occurred in patients who had prolonged clinical treatment (more than 35 days) and one patient died of severe fungal endocarditis. The follow-up of the remaining 26 patients varied from 1 to 596 weeks (mean 183) demonstrating important clinical improvement and a normally functioning valve prosthesis. All patients remained in functional class I or II. The analysis of our data indicates that surgical treatment is the best option for high risk endocarditis and should be undertaken earlier in all patients in this group.
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PMID:[Surgical treatment of high-risk valvar endocarditis]. 262 78

The authors have studied the short and long term results of surgical treatment of acute phase of infectious endocarditis in a group of 33 high risk patients with valvular heart disease. The age varied from 2 to 68 years; 18 patients were male and 22 were of the white race. The aortic valve was most frequently involved (18/54.5%), followed by the mitral valve (13/39.3%) and tricuspid valve (2/6.0%). Twenty four patients (72.7%) were in functional class III and seven (21%) in functional class IV. The noninvasive studies in those patients revealed 13 cases (39.4%) with normal cardiac size. The ECG was abnormal in 27 cases (81.8%) mostly with left atrial and ventricular hypertrophy. The echocardiogram revealed the presence of vegetations in 27 patients (81.8%) and blood cultures were positive in 22 cases (66.6%). All patients were treated with antibiotics. The pathologic analysis revealed the presence of vegetations in 94% and structural alterations in 16.5%. Twenty-one patients had heart valve replacement with mechanical prosthesis (63.6%), 11(33.3%) had bioprosthesis and one had tricuspid excision without replacement (3.0%). The hospital mortality was 12% and the late mortality 3%. Three deaths occurred in patients who had prolonged clinical treatment (more than 65 days) and one patient died of severe fungal endocarditis. The follow-up of the remaining 26 patients varied from 01 to 448 weeks (mean 183) demonstrating important clinical improvement and a normally functioning valve prostheses. All patients are in functional class I and II. The analysis of our data indicates that surgical treatments is the best option for high risk endocarditis and should be undertaken earlier in all patients in this risk group.
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PMID:[Surgical treatment of high-risk valvular endocarditis]. 263 58

A case of Clostridium bifermentans endocarditis occurred in a 23-year-old man who was an intravenous drug user. There was no history of preexisting valvular heart disease. He was initially treated with high-dose penicillin G potassium but remained bacteremic for a ten-day period. The bacteremia resolved when the therapy was changed to metronidazole hydrochloride. A review of the 16 reported cases of clostridial endocarditis showed no predisposing host factor to the development of the disease. Penicillin is the treatment of choice for clostridial endocarditis, but metronidazole should be considered as an alternate therapy for treatment that fails.
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PMID:Clostridial endocarditis. Report of a case caused by Clostridium bifermentans and review of the literature. 264 5

We report a series of five cases of infective endocarditis caused by Streptococcus agalactiae (group B streptococcus) in Glasgow over a 30 month period. There were three males and two females mean age 48.6 years (range 28-63 years). Only one patient had previous valvular heart disease. The infections were characterised by an acute presentation and an aggressive course with major arterial emboli. Despite early diagnosis and appropriate intravenous antibiotics three patients died, one after valve replacement and two before surgery could be undertaken. The remaining two patients had successful valve surgery and have recovered. S. agalactiae endocarditis is an uncommon but important condition which carries a high mortality. The infection is difficult to control with antibiotics alone and therefore early surgery may be indicated.
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PMID:Infective endocarditis caused by Streptococcus agalactiae. 267 Jul 80

One hundred sixty-eight opiate addicts, whose hearts were submitted for necropsy study, were examined with prime focus on modes of death and types of cardiac abnormalities. Twenty various modes of death were identified: active infective endocarditis or its consequences in 67 (40%), drug overdose in 39 (24%), coronary artery disease in 14 (8%), pulmonary granulomatosis in 7 (4%) and 15 various diseases (7 cardiac and 8 noncardiac) in the remaining 41 (24%) patients. Of the 168 hearts examined, only 7 (4%) were normal. Although infective endocarditis (active, healed or both) was most common (80 [48%] patients), there was a broad range of other cardiac abnormalities present: cardiomegaly in 114 (68%) (including 22 patients without another cardiac abnormality), coronary artery disease in 35 (21%), acquired valvular heart disease in 16 (10%), myocardial heart disease in 14 (8%) and a congenital cardiac anomaly in 19 (11%). Of the 35 hearts with various coronary artery diseases, 28 had significant (greater than 75%) narrowing of the cross-sectional area of 1 or more of the 4 major (left main, left anterior descending, left circumflex and right) epicardial coronary arteries by atherosclerotic plaque. Of 112 coronary arteries in these 28 hearts, 52 (46%) were significantly narrowed (a mean of 1.9 of the 4 major coronary arteries/patient). In 27 of these 28 cases, each 5-mm segment of the 4 major coronary arteries was examined histologically. Of the 1,435 five-mm segments examined, 189 (13%) were narrowed 76 to 100% in cross-sectional area by plaque; 347 (24%), 51 to 75%; 336 (23%), 26 to 50%; and 563 segments (39%) were narrowed 0 to 25% in cross-sectional area by plaque. The percents of 5-mm segments narrowed 76 to 100% in cross-sectional area were greater in those patients with (128 of 793 [16%]) than without (61 of 642 [9%]) clinical evidence of myocardial ischemia (p = 0.001). In this study a very high frequency of cardiac abnormalities (161 [96%]) was found at necropsy and most deaths (97 [58%]) were related to cardiac disease. Although death was most often due to diseases whose association to opiate addiction is well recognized (such as infective endocarditis, drug overdose and pulmonary granulomatosis from the venous injection of talc), several other modes of death were present. Most prominent among these was coronary artery disease (14 patients [8%]).
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PMID:Modes of death and types of cardiac diseases in opiate addicts: analysis of 168 necropsy cases. 280 61

Rheumatic fever leading to advanced valvular heart disease, in adults and children, is still frequently seen in developing countries. In the period 1981-87, 1137 patients underwent open heart surgery for either repair (489 patients), or replacement (639 patients) of defective cardiac valves. The experience with 75 children who underwent mitral valve replacement among this group is reviewed. The aetiology of mitral valve disease was rheumatic in 71, and infective endocarditis in four; 85% of the children were in NYHA functional class III, and 15% in class IV. Seven children had intra-operative findings of rheumatic activity. Pure mitral regurgitation was seen in 41, while mixed mitral valve disease was observed in 34 children. Twenty-seven children underwent mitral valve replacement with Ionescu-Shiley bovine pericardial valves, and 48 with mechanical Bi-leaflet valves. The operative mortality was 9.3%, and the actuarial survival rate, calculated by the Cutler and Ederers method, was 87% at 5 years.
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PMID:Mitral valve replacement in children. 305 98


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