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

Two patients have been documented in whom a preexisting left ventricular aneurysm became complicated by myocardial abscess. Presumptive clinical diagnoses of infected pulmonary infarction and recurrent myocardial infarction were made. In each instance the abscess was revealed at necropsy. Histologic studies suggested that the abscess had occurred through direct spread from an infectious mural endocarditis. This mechanism could be related to the nature of the inner coating, which in both instances revealed evidence of organizing thrombosis with incorporation into the wall of the aneurysms. The observations reemphasize the need to consider the possibility of an infectious cardiac complication in every patient who presents with puzzling and nondiagnostic symptoms but in whom signs of an infectious process are present.
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PMID:Cardiac aneurysm complicated by Salmonella abscess. A clinicopathologic correlation in two patients. 689 68

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
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PMID:Infective endocarditis update experience from a heart hospital. 697 38

We reviewed a consecutive series of 90 patients undergoing concomitant resection of ascending aortic anerysm and aortic valve replacement (AVR) utilizing noncomposite "conventional" techniques in order to assess the early and late results, to define limitations of this operative approach, and thereby to clarify the indications for composite reconstruction of the aortic root. Mean age was 55 years. Twenty percent had Marfan's syndrome, and 13% had aortic dissections. The cause of the aneurysm was dissection in 13% of cases, syphilis in 11%, atherosclerosis in 9%, and degeneration (with or without cystic medionecrosis) in 67%. Follow-up averaged 3.8 years and extended to 11.5 years maximum. AVR and complete excision of the aneurysm (preserving small tongues of aortic wall circumscribing the coronary artery ostia) coupled with tubular graft replacement of the ascending aorta were performed. Nineteen percent of patients required individual technical modifications relating to the coronary arteries. Operative mortality rate was 13%, with the majority of deaths being due to cardiac causes. Contemporary (1975 to 1978) operative mortality rate was 4.3%. Seven percent required re-exploration for hemorrhage and 2.4% had perioperative myocardial infarctions. Late functional results were generally good (average N.Y.H.A. Class 1.4). Late thromboembolism, angina, myocardial infarction, and congestive heart failure occurred at linearized rates of 3.4% per patient-year, 4.9% per patient-year, 1.1% per patient-year, and 5.2% per patient-year, respectively. No prosthetic valve endocarditis, graft infection, or recurrent aneurysms of the aortic root were observed. Late reoperation was necessary in eight patients (3% per patient-year), but reoperation for disease confined to the ascending aorta accounted for only three of these cases (1.1% per patient-year). Overall actuarial survival rates were 67% +/- 5% at 5 years and 50% +/- 9% at 10 years; survival rates for the 78 operative survivors were 77% +/- 5% and 57% +/- 10% at the same time intervals, respectively. Only one late death could be attributed to complications arising in the reconstructed aortic root. These results confirm that such simple, noncomposite techniques are safe, portend minimal risk of late complications and the attendant necessity for reoperation, and provide satisfactory long-term survival. We believe that composite techniques should be primarily reserved for selected cases of advanced necrotizing prosthetic or natural endocarditis.
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PMID:Concomitant resection of ascending aortic aneurysm and replacement of the aortic valve: operative and long-term results with "conventional" techniques in ninety patients. 698 12

A case of pneumococcal endocarditis, complicated by a left ventricular-right atrial fistula and a rapidly progressing cardiac failure in a 56 year-old man, is reported here. In the acute period, an aortic valve prosthesis was installed and the atrio-ventricular fistula was closed with patches of pericardium. After serious post-operative complications, the patient left the clinic, cured of his bacterial endocarditis. He unfortunately died two months later of a massive myocardial infarction caused by a previously unrecognized atheromatous stenosis of the anterior descending branch and occlusion of the circumflex vessel. The authors discuss the bacteriological, anatomopathological and clinical aspects of this rare complication of bacterial endocarditis in light of the current available literature.
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PMID:Pneumococcal aortic valvar endocarditis with atrio-ventricular perforation. 710 95

We reviewed 56 cases of infective endocarditis (IE) in patients 65 years of age and older. The clinical features, laboratory manifestations, and bacterial etiology of IE in our patients were similar to those in younger patients. Ninety-three percent were febrile, 86% had heart murmurs, and 36% had peripheral stigmas. Streptococci were predominant in community-acquired cases and staphylococci in nosocomial infections; most patients (89%) had persistent bacteremia. Preexisting valvulitis was present in only 23% of patients; 34% had evidence of atherosclerotic heart disease. Complications included congestive heart failure (CHF) in 64%, neurologic sequelae in 36%, and myocardial infarction in 13%. The mortality rate was 45%. A significantly increased mortality was associated with neurologic sequelae, myocardial infarction, or IE with Staphylococcus aureus. The diagnosis of IE should be considered in any elderly patient with a fever, heart murmur, worsening CHF, or an acute cerebrovascular insult.
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PMID:Infective endocarditis in the elderly. 743 45

Traditionally, group C streptococci include four species: Streptococcus equisimilis, S. zooepidemicus, S. equi, and S. dysgalactiae, the first three of which are group C beta-hemolytic streptococci (GCBHS). However, many of the beta-hemolytic streptococci carrying Lancefield group C antigen isolated from clinical specimens are S. milleri. These organisms can be differentiated by colony size. We retrospectively collected data concerning large-colony-forming GCBHS bacteremia that occurred during a period of 8 years at the Massachusetts General Hospital. A total of 222 cases of beta-hemolytic streptococcal bacteremia were identified; data on the Lancefield grouping were available in 192 cases: 45 cases (23.6%) were group A, 96 cases (50%) were group B, 7 cases (3.6%) were group C (large colony forming), and 44 cases (22.9%) were group G. The medical records for cases of large-colony-forming GCBHS bacteremia were reviewed. In one case, the isolate was thought to be a contaminant; the other six cases are reported (five males and one female; mean age, 55 years). All patients had severe underlying conditions, and none had a history of exposure to animals. The clinical syndromes included two cases of cellulitis and one case each of endocarditis, myocardial infarction complicated by infection, pneumonia, and myofasciitis. The diagnoses for two patients with endovascular infections were delayed. Three of the six patients had fatal outcomes, and other two, after prolonged hospitalization, were transferred to a long-term rehabilitation center. We concluded that the severe outcomes reflect delay in diagnosis and treatment as well as the severity of the underlying diseases. The taxonomy of GCBHS is discussed. More reports differentiating large- and small-colony-forming GCBHS are needed.
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PMID:Report of cases of and taxonomic considerations for large-colony-forming Lancefield group C streptococcal bacteremia. 755 58

A case of ruptured septic myocardial infarct with death from cardiac tamponade in an intravenous drug addict with left-sided infective endocarditis and septic coronary artery embolism is described. To the best of our knowledge, there is no previous report of such a case in the literature. Although uncommon, infective endocarditis with coronary embolisation is a well-documented cause of myocardial infarction, although not normally associated with ventricular free wall rupture, and should be considered in intravenous drug addicts who present with cardiac symptoms and signs of sepsis.
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PMID:Sudden death from ruptured septic myocardial infarct in an intravenous drug addict. 759 May 50

Left ventricular-right atrial communication may be a congenital defect or can result from trauma, endocarditis, or valve replacement. Traditionally the preoperative diagnosis of this entity was made during cardiac catheterization, but recent advances in echocardiography, particularly color Doppler imaging, have greatly facilitated the noninvasive diagnosis of left ventricular-right atrial communication. We present four cases of left ventricular-right atrial communication, each identified by two-dimensional and color Doppler imaging. One case is a congenital defect, two were identified years after cardiac surgery, and one presents as an unusual complication of myocardial infarction. Optimal views for identifying this defect are discussed along with clues to quantifying its hemodynamic significance.
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PMID:The spectrum of left ventricular-right atrial communications in the adult: essentials of echocardiographic assessment. 764 19

A 28-year-old man with a history of rheumatic heart disease, alcoholism and amphetamine abuse presented with severe left upper quadrant abdominal pain and persistent fever. He stayed at home for the previous two months due to intermittent dull lower abdominal pain, chills, fever and tarry stools without seeking medical help. A diagnosis of infective endocarditis with splenic infarcts and a renal infarct was made based on the echocardiographic and abdominal computer tomography scan findings. His clinical course was complicated by an acute inferior wall myocardial infarction and cerebral hemorrhage. Despite aggressive medical treatment, his condition deteriorated. One month later, his condition became more critical with pneumonia and intractable shock, and his family requested his discharge. He died soon after leaving the hospital.
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PMID:Widespread embolism in a patient with infective endocarditis--a case report. 776 62

The etiology of the papillary muscle rupture includes myocardial infarction, trauma, hypertension, myxomatous degeneration, endocarditis etc. We report a case of partial papillary muscle rupture whose etiology was unknown, in a 77-year-old woman. The preoperative catheterization and coronary angiography showed severe mitral regurgitation and no significant coronary stenosis. And we recognized the mass waving into the left atrium in systole with the echocardiogram. At surgery, we repaired the mitral valve by resecting quadrangular areas of the posterior leaflet including the attachment of the torn papillary muscle. Additionally a number 28 Carpentier-Edwards mitral annuloplasty ring was sewn in place. In pathologic specimen, there were focal fibrosis, necrotic muscle, lymphocytes, and no vegetation.
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PMID:[A case of mitral regurgitation due to partial papillary muscle rupture whose etiology was unknown]. 786 42


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