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

From July 1981 to October 1988, 1597 native valves, 926 (58%) mitral and 671 (42%) aortic, were excised. The gross and histological features of all valves were studied using routine histochemical, immunohistochemical and electron microscopy techniques. As far as mitral valve is concerned the lesions were: stenosis 263 (28.6%), stenosis + incompetence 537 (57.8%) and incompetence 126 (13.6%). Our study was limited to the valves of patients undergoing mitral valve replacement because of pure incompetence. The pathological alterations of the valves were: floppy mitral valve (FMV) 59 (46.8%), rheumatic disease (RD) 50 (39.6%), infective endocarditis (IE) 13 (10.3%), papillary muscles ischemic disease (PMID) 4 (3.1%). In the FMV group the associated lesions were: aortic valve incompetence due to floppy aortic valve and noninflammatory aortic root disease (9-15.2%), tricuspid valve incompetence (4-7.8%) and atrial septal defect (7-13.7%). The commonest complication in this group was rupture of chordae tendineae requiring urgent surgery. In the RD group there was a high incidence of active rheumatism, valvulitis and papillary muscles myocarditis (37-74%) despite the laboratory data were within normal ranges. In the IE group there was an associated aortic endocarditis in 7 patients (53.8%). The FMV was the commonest cause of pure incompetence in patients who had mitral valve replacement. Rheumatic pure mitral incompetence was always associated in our experience to signs of active rheumatic disease.
 ...
PMID:[Etiology and incidence of pure mitral insufficiency: a morphological study of 926 native valves]. 224 33

The feasibility, safety and clinical impact of transesophageal echocardiography were evaluated in 51 critically ill intensive care unit patients (28 men and 23 women; mean age 63 years) in whom transthoracic echocardiography was inadequate. At the time of transesophageal echocardiography, 30 patients (59%) were being mechanically ventilated. Transesophageal echocardiography was performed without significant complications in 49 patients (96%), and 2 patients with heart failure had worsening of hemodynamic and respiratory difficulties after insertion of the transesophageal probe. The most frequent indication, in 25 patients (49%), was unexplained hemodynamic instability. Other indications included evaluation of mitral regurgitation severity, prosthetic valvular dysfunction, endocarditis, aortic dissection and potential donor heart. In 30 patients (59%), transesophageal echocardiography identified cardiovascular problems that could not be clearly diagnosed by transthoracic echocardiography. In the remaining patients, transesophageal echocardiography permitted confident exclusion of suspected abnormalities because of its superior imaging qualities. Cardiac surgery was prompted by transesophageal echocardiographic findings in 12 patients (24%) and these findings were confirmed at operation in all. Therefore, transesophageal echocardiography can be safely performed and has a definite role in the diagnosis and expeditious management of critically ill cardiovascular patients.
 ...
PMID:Transesophageal echocardiography in critically ill patients. 225 98

In a 10-month-old infant with purulent pneumococcal meningitis without structural heart disease acute infectious endocarditis developed. Echocardiographic examination revealed vegetations on both cusps of the mitral valve. With regard to the age and critical condition of the infant, in the acute stage surgical removal of the vegetations, was not indicated. During long-term intravenous antibiotic therapy the vegetations on the mitral valve and clinical and laboratory manifestations of endocarditis disappeared. The valve was, however, devastated and the child developed severe mitral insufficiency. Because of progressive cardiac failure which could not be controlled by drugs, at the age of 19 months a plastic operation of the mitral valve had to be performed after which the haemodynamics and clinical condition improved markedly.
 ...
PMID:[Pneumococcal infectious endocarditis in an infant (case report)]. 228 69

Infection of the mitral-aortic intervalvular fibrosa occurs most commonly in association with infective endocarditis of the aortic valve. Infection of the aortic valve results in a regurgitant jet that presumably strikes this subaortic interannular zone of fibrous tissue and produces a secondary site of infection. Infection of this interannular zone then leads to the formation of subaortic abscess or pseudoaneurysm of the left ventricular outflow tract. This infected zone of mitral-aortic intervalvular fibrosa or subaortic aneurysm can subsequently rupture into the left atrium with systolic ejection of blood from the left ventricular outflow tract to the left atrium. This report describes the echocardiographic findings in three patients with pathologically proved left ventricular outflow tract to left atrial communication. Precise preoperative diagnosis is important, and this lesion should be differentiated from ruptured aneurysm of the sinus of Valsalva and perforation of the anterior mitral leaflet. Transthoracic echocardiography using color flow imaging and conventional Doppler techniques may show an eccentric mitral regurgitation type of signal in the left atrium originating from the region of the left ventricular outflow tract. However, transesophageal echocardiography provides an accurate preoperative diagnosis and should be used intraoperatively during repair of such lesions.
 ...
PMID:Left ventricular outflow tract to left atrial communication secondary to rupture of mitral-aortic intervalvular fibrosa in infective endocarditis: diagnosis by transesophageal echocardiography and color flow imaging. 229 90

This case report describes a patient with an uncommon type of mitral incompetence caused by a perivalvular communication between the left ventricle (LV) and the left atrium (LA) masked by a considerable fibrotic subvalvular aortic stenosis, endocarditis and congestive heart failure (CHF). A 64 year old farmer with a history of a systolic murmur since childhood complaining of increasing fatigue and dyspnoea, temperature over 39 degrees C, and signs of CHF was admitted and transferred to a cardiological unit. Invasive examination and continuing clinical deterioration caused urgent transfer for surgery under suspicion of a decompensated hypertrophic obstructive cardiomyopathy. Clinical investigation revealed a decompensated subvalvular aortic stenosis and a mild mitral insufficiency. At surgery the advanced fibrotic subvalvular stenosis was resected. After coming off bypass severe mitral insufficiency was detected by intraoperative analysis of the simultaneous intracavitary-pressure tracings. A midsystolic maximum of a high V-wave of the LA-pressure tracing was suggestive of an unusual reason of the mitral insufficiency. Reexploration indicated a perivalvular broad communication from the LA groove to the LV with an otherwise normal mitral valve. The communication was closed using buttressed mattress-sutures. This uncommon type of mitral incompetence via a perivalvular LA-LV communication was probably caused by endocarditis and an intramyocardial abscess in the LA-wall which subendocardially led to LV-LA communication.
 ...
PMID:Uncommon type of mitral insufficiency caused by perivalvular communication between left ventricle and left atrium. 230 25

A 25-year-old woman with active systemic lupus erythematosus and infective endocarditis was seen initially with porcine aortic bioprosthetic stenosis, perivalvar regurgitation, and native mitral regurgitation 9 years after aortic valve replacement for lupus endocarditis. Double-valve replacement was performed with St. Jude Medical mechanical prostheses. After operation the patient developed fever and an elevated white blood cell count. One month later she had increasing mitral and aortic perivalvular regurgitation and intermittent complete heart block. At reoperation both annuli showed evidence of continued infection, and she underwent annular reconstructions with pericardium and double-valve re-replacement. Cultures grew Mycoplasma hominis. Despite long-term therapy with appropriate antibiotics, within 2 months she developed recurrent perivalvar regurgitation with congestive heart failure. Orthotopic heart transplantation was performed. The postoperative course was notable for significant leukocytosis and spontaneous culture negative hemothorax that required thoracotomy for drainage. The patient recovered and is now well 14 months after operation.
 ...
PMID:Heart transplantation for intractable prosthetic valve endocarditis. 231 73

A case of WPW syndrome combined with mitral regurgitation caused by infective endocarditis underwent surgical division of accessory pathway and mitral valve replacement preserving posterior leaflet simultaneously. A 56-years old woman suffered atrial fibrillation with pseudo VT and cardiac failure caused by mitral regurgitation. Electro-physiological study (EPS) revealed accessory pathway in postero-lateral wall in left atrium and atrio-fascicular pathway like James bundle in AV node. ECHO cardiography showed mitral valve prolapse and severe regurgitation. Accessory pathway was divided surgically and deep freeze coagulation was followed. Perforation of anterior leaflet and chordal rupture of posterior leaflet caused by infective endocarditis were repaired by annuloplasty (Kay and McGoon method) at first, but regurgitation retained moderately. After re-clamping of aorta, mitral valve was replaced with prosthesis (SJM 29 mm) preserving posterior leaflet. Postoperative examination revealed division of accessory pathway and no regurgitation of mitral prosthesis.
 ...
PMID:[Simultaneous operation of WPW syndrome combined with mitral regurgitation caused by infective endocarditis]. 234 36

Among 206 consecutive patients having undergone mitral valve repair with a prosthetic ring between 1972 and 1979 in our institution, the 195 patients (94.5%) who survived the operation were studied to assess the long-term function of this method of repair. Patients' ages ranged from 18 to 79 years (mean age 48.7 years). Mitral valve insufficiency was due to degenerative disease in 113 patients (58%), rheumatic disease in 74 (38%), ischemia and other causes in eight patients (4%). A total of 188 patients (9.7%) were in New York Heart Association class III or IV preoperatively and 94 (48%) had atrial fibrillation. The patients were divided into three functional groups: type I (normal leaflet motion), 35 patients (18%); type II (leaflet prolapse), 147 patients (75%); and type III (restricted leaflet motion), 13 patients (7%). The techniques included prosthetic ring annuloplasty (185 patients), leaflet resection (158 patients), chordal shortening (89 patients), leaflet mobilization (10 patients) and papillary muscle reimplantation (2 patients). Long-term follow-up was available in 189 patients (96.8%), for a rate of 2316 patients per year. The 15-year actuarial and valve-related survival rates were 72.4% and 82.8%, respectively. At 15 years, 93.9% of the patients were free from thromboembolism, 96.6% free from endocarditis, 95.6% free from anticoagulant-related hemorrhage, and 87.38% free from reoperation. Actuarial rate of freedom from reoperation was higher in the group with degenerative disease (92.7%) than in the group with rheumatic disease (76.12%). Among the 157 survivors, 117 (74%) were in New York Heart Association class I and class II and 105 (66%) were in sinus rhythm. Doppler echocardiographic studies showed normal ventricular contractility in 134 patients (84.5%), absence of mitral regurgitation in 112 (74%), trivial regurgitation in 27 (17%), and significant regurgitation in 4 patients (2.5%).
 ...
PMID:Valve repair with Carpentier techniques. The second decade. 235 39

From 1974 to 1984, 46 patients underwent emergency surgery for acute native valve endocarditis. Urgent valve replacement was necessary because of rapid hemodynamic deterioration in 34 (73%), uncontrolled sepsis plus heart failure in 9 (19%), and life-threatening emboli in 3 (7%) patients. At the time of surgery 23 patients (50%) were in NYHA functional class IV, 20 in Class III, and 3 in class II. Streptococcus was the most common organism encountered, followed by staphylococcus. Thirty-four cases presented severe aortic regurgitation, 3 mitral incompetence, 8 mitral plus aortic insufficiency, and one aortic plus tricuspid insufficiency. Operative mortality rate was 17% (8/46). Most deaths were due to preoperative multiple system deterioration, especially in cases with lesions of both the aortic and mitral valves, and were unrelated to the duration of preoperative antibiotic therapy. The postoperative observation period of long-term survival is from 6 to 102 months (= 44 months). There were 7 late deaths. The actuarial survival, including operative mortality, is 67%. Twenty-two patients are now in NYHA class II, 6 in class III. The duration of postoperative antibiotic treatment (6 weeks in our series) seems to be important for the prevention of reinfection, early surgery is of great benefit; our 31 survivors showed an excellent clinical improvement.
 ...
PMID:Valve replacement in acute native valve endocarditis. 242 26

(1) Carpentier techniques of repair are the dominant method today because of durability and reproducible results. (2) Mitral valve repair results in high survival, low risk of anticoagulant-related complications, and low risk of infective endocarditis. (3) Long-term anticoagulation is avoided in approximately half of the patients; yet, over the long term, thromboembolism occurs significantly less with repair than with valve replacement. (4) The rate of reoperation after mitral valve repair is not significantly different from that of mechanical valve replacement up to 10 postoperative years. (5) Mitral valve repair for degenerative mitral regurgitation results in a higher freedom from reoperation at 5 years and beyond, compared with rheumatic causes of regurgitation. (6) Ischemic and congenital etiologies for mitral regurgitation demand repair whenever feasible. Results in these patient groups favor repair over other options.
 ...
PMID:Long-term results of mitral valve repair. 248 24


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>