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

During a six-year period 15 consecutive patients with isolated aortic regurgitation due to infective endocarditis were encountered. None had prior significant aortic valve disease. Elective valve replacement was performed in 13 patients; emergency operation was needed in only 1 patient because of intractable pulmonary edema. One patient died suddenly from acute heart block while undergoing medical treatment. Preoperative cardiac catheterization studies in 10 of the 14 patients revealed gross elevations of left ventricular end-diastolic pressure, pulmonary hypertension, depressed cardiac output, and 3 to 4+ aortic regurgitation. There was 1 early and 1 late postoperative death, both due to systemic embolism, yielding an overall surgical mortality of 14%. After a mean follow-up of 18 months, 10 of the 11 patients are in New York Heart Association Functional Class I. Most patients with acute aortic regurgitation secondary to infective endocarditis have clinically observable congestive heart failure and will eventually require valve replacement. If congestive heart failure can be stabilized by a medical regimen, a course of antibiotic therapy can be administered and elective valve replacement can be performed. The time taken for preoperative antibiotic treatment is not associated with irreversible myocardial damage sufficient to influence the results of operation.
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PMID:Surgical treatment of acute aortic regurgitation in infective endocarditis. 99 71

A 26 year old Saudi man with features of both Loeffer's endocarditis and endomyocardial fibrosis presented with mild symptoms and pulmonary emboli. Echocardiographic examination showed obliteration of the right ventricular apex by an attached mass. The results of haemodynamic studies were somewhat abnormal and medical treatment was started. Despite anticoagulation with warfarin the patient's condition deteriorated rapidly over a four month period after a further episode of pulmonary embolism and the development of pulmonary hypertension. Two haemodynamic studies performed four months apart were typical of pulmonary hypertension and later right ventricular failure; they showed none of the characteristics of restriction. Pulmonary embolectomy was attempted but there was no cleavage plane between the organised thrombi and the endothelium of the pulmonary artery. The patient died of severe pulmonary hypertension and right ventricular failure several days after operation. Surgical intervention in the early stages of right-sided endomyocardial fibrosis might have prevented the development of pulmonary embolism and pulmonary hypertension.
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PMID:Right-sided endomyocardial fibrosis with recurrent pulmonary emboli leading to irreversible pulmonary hypertension. 138 68

Retrospective studies have been conducted in Lyon (33 patients) and Montreal (24 patients) in order to compare the results of transventricular valvotomy (TVV, 20 cases) and aortic valvotomy with cardiopulmonary bypass (CPB, 37 cases) in neonatal critical aortic stenosis. Clinical, echocardiographic, catheterization and operative data were analyzed in order to determine prognostic factors. Mortality rate was 59%: 30/34 perioperative deaths in the first month, and 4 late deaths after a reintervention for severe residual obstruction. Long term follow up was available for 23 patients (41%) for a 2 to 16 year period (mean 7.5). Five patients (7%) required a reintervention six years after the initial operation. Two of them required valve replacement. Eighteen patients (31%) surviving the initial operation, displayed a satisfactory result, being free of symptoms, endocarditis, reoperation and sudden death. Factors that influenced the outcome included severe heart failure, a left ventricular end-diastolic diameter below 14 mm, an aortic valve annulus below 8 mm, and a poor shortening fraction. Factors that did not influence the prognosis were age, pulmonary hypertension, and the anatomic type of the valve. Trans-aortic valvotomy with CPB was associated with a smaller operative mortality and a better long term result than TVV.
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PMID:[Results of the surgical treatment of critical aortic valve stenosis in the newborn infant]. 164 44

Twenty-nine patients underwent closure of patent ductus arteriosus (PDA) via pulmonary arteriotomy under low-flow extracorporeal circulation combined with profound hypothermia. No complications from air embolism or hemorrhage were encountered during the operation. The early and late results were satisfactory. This technique was used as a safe method for PDA complicated by severe pulmonary hypertension, infective endocarditis, recurrence of ductal patency and for PDA in adults or coexistence of intracardiac anomaly.
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PMID:[Closure of patent ductus arteriosus under extracorporeal circulation through pulmonary arteriotomy]. 181 5

We evaluated 77 patients with symptomatic mitral stenosis for balloon valvuloplasty. Five patients were excluded from the procedure due to the presence of intra-atrial thrombi or mitral valve endocarditis as detected by 2D echocardiography. The mean age of the 72 treated patients was 38 +/- 11 years, 68 were NYHA functional class II or IV: only 6 patients had valvular calcification. Three patients had severe liver failure, 2 were chronic alcoholics, one had liver cirrhosis, 2 had severe weight loss and 13 had pulmonary hypertension at systemic levels. 69 patients had a technically adequate procedure, one patient died, 1 developed cardiac tamponade and 1 failed. Mitral valve area increased from 0.93 +/- 0.34 to 2.38 +/- 0.67 cm2. Mitral incompetence increased in only 16 patients. After a mean follow up period of 15 +/- 5 months (range 8 to 27), 56 patients remained in FC I or II. Mitral valve area remained satisfactory in 54 patients. Mitral valve anatomy evaluated by echocardiography is helpful to predict immediate and late outcome. We conclude that balloon mitral valvuloplasty is the first choice for patients with severe symptomatic mitral stenosis.
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PMID:[Percutaneous mitral valvuloplasty as a treatment of choice for mitral stenosis. Immediate results and long-term follow-up]. 184 2

A clinically undetectable, small ductus arteriosus was identified by Doppler ultrasonography in 21 individuals. Infants were excluded from the study and no patient had pulmonary hypertension. Persistence of the ductus arteriosus is likely to be more common than shown by less sensitive diagnostic methods. Some patients considered to have infective endocarditis with a normal heart may have a silent ductus arteriosus. Evidence of such an association would justify ligation or antibiotic cover as prophylactic measures.
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PMID:Doppler ultrasound and the silent ductus arteriosus. 848 97

We report the clinical and pathological findings in a young female patient who was a chronic drug addict for over eight years. In 1984, she presented with tricuspid endocarditis and three years later, was found to have irreversible pulmonary hypertension. Post-mortem examination revealed not only persistent tricuspid endocarditis and evidence of repeated pulmonary thromboembolism explaining her pulmonary hypertension but also a diffuse eosinophilic myocarditis, with myocardial fibre degeneration. The combined pulmonary and myocardial lesions have rarely been documented in the same drug addict. The relationship of these various pathological findings are discussed in the light of the existing literature.
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PMID:[Eosinophilic myocarditis and pulmonary hypertension in a drug-addict. Anatomo-clinical study and brief review of the literature]. 218 8

Heart disease is the most important nonobstetric cause of maternal death; however, most young women with heart disease do well during pregnancy. If the physician is uncertain of the effects of pregnancy on a particular heart condition, needless restrictions may be imposed. The main hazards are: pulmonary edema when it occurs suddenly in mitral stenosis; pulmonary hypertension (because pulmonary vascular disease tends to be exacerbated by pregnancy); infective endocarditis (this is rare); and fulminating peripartum cardiomyopathy. The practical management of the pregnant patient with various concomitant heart conditions (congenital heart disease, pulmonary hypertension, rheumatic heart disease, anticoagulants and artificial valves, constrictive pericarditis, kyphoscoliosis, Marfan's syndrome, mitral prolapse, hypertrophic cardiomyopathy, dilated cardiomyopathy, infective endocarditis, and arrhythmias) is discussed. An absolute indication for therapeutic abortion is severe pulmonary vascular disease; discretionary indications include 'chronic thromboembolic pulmonary hypertension,' cardiomyopathies (depending on the hemodynamic disturbance), and Marfan's syndrome.
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PMID:Cardiovascular disease in pregnancy. 218 16

Patients undergoing valvulectomy for isolated tricuspid valve endocarditis offer the unique opportunity to study the effects of acquired right ventricular volume overload on left ventricular filling in persons free of pulmonary hypertension and preexisting left heart disease. Eleven patients who had undergone total or partial removal of the tricuspid valve were compared with 11 age-matched control subjects; Doppler echocardiographic techniques were used to quantify changes in left ventricular filling and to relate them to changes in left ventricular and left atrial geometry caused by right ventricular and right atrial distension. The late diastolic fractional transmitral flow velocity integral, a measure of the left atrial contribution to left ventricular filling, was significantly decreased in patients undergoing tricuspid valvulectomy compared with control subjects (0.22 +/- 0.11 versus 0.32 +/- 0.09; p less than 0.04). Severe tricuspid regurgitation in these patients resulted in marked right atrial distension, reversal of the normal interatrial septal curvature and compression of the left atrium such that left atrial area was significantly smaller than in control subjects (5.9 +/- 2.2 versus 8.6 +/- 1.2 cm2/m2; p less than 0.005). Acting as a receiving chamber, the left ventricle was maximally compressed by the volume-overloaded right ventricle in late diastole, coincident with the timing of atrial systole, resulting in a significant increase in the left ventricular eccentricity index compared with that in control subjects (1.35 +/- 0.14 versus 1.03 +/- 0.1; p less than 0.001). Thus, right ventricular volume overload due to severe tricuspid regurgitation results in left heart geometric alterations that decrease left atrial preload, impair left ventricular receiving chamber characteristics and reduce the atrial contribution to total left ventricular filling.
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PMID:Reduced atrial contribution to left ventricular filling in patients with severe tricuspid regurgitation after tricuspid valvulectomy: a Doppler echocardiographic study. 225 48

1. Laennec's lung disease lasted for at least 20 years. Its stigmata included chronic cough, sputum production and intermittent wheeze. 2. Laennec had long term stigmata commonly associated with chronic bronchiectasis, sinusitis, physical frailty, and short stature (5ft 2in). 3. Chronic diarrhoea of at least 20 years duration is not strongly associated with tuberculosis. 4. During Laennec's last illness his physicians equivocated as to whether he had respiratory disease at all. Bronchial breathing at the apex, if indeed present, could have been caused by compensatory emphysema secondary to middle lobe bronchiectasis rather than to active tuberculosis. 5. Laennec did not have haemoptysis in his final illness. 6. Laennec's last illness, a wasting illness characterised by intermittent fevers, cardiac murmur, and persistent tachycardia followed a dental manipulation. The painful "abdominal abscess" noted by Laennec's colleagues may actually have been splenomegaly. These features suggest endocarditis. The cardiac murmurs associated with pulmonary hypertension secondary to bronchiectasis are not usually audible at a remote distance from the patient. Endocarditis was a disease largely unknown to physicians of the early 19th century before Osler clarified its pathology in the 1880s.
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PMID:Rene Laennec: his brilliant life and tragic early death. 266 72


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