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

An individual who had sustained 43% burns and then developed blood culture negative right ventricular infective endocarditis and right basal segmental pulmonary infarction is reported. Echocardiography detected vegetations in the mid right ventricle. The patient had a central venous catheter in situ during the initial stage of management of burns. Following therapy, he recovered uneventfully from his extremely toxic and febrile state.
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PMID:Right ventricular mural infective endocarditis in a patient with burns. 163 69

Endovascular infections that involve the right side of the heart present their own unique etiologies, pathophysiologies, clinical manifestations, and therapeutic issues. The pathology of the vegetations of right-sided endocarditis is identical to that of left-sided endocarditis. These vegetations are irregular, friable masses of varying size the contain platelets, fibrin, RBCs, and microorganisms. These lesions serve as a nidus for deep-seated infection and produce sustained bacteremia. Right-sided endocarditis occurs in 5% to 10% of all cases of endocarditis. The most common predisposing factors are IV drug abuse and congenital heart disease. S. aureus is the most common pathogen. The clinical manifestations include fever, chills, rigor, dyspnea, pleuritic pain, productive cough, and hemoptysis. The cardiac manifestations can be notably absent early in the course of the disease, with only 20% of patients initially showing a significant murmur on physical examination. Peripheral embolic lesions can be seen. Echocardiography is helpful in identifying vegetations on the tricuspid valve in a significant proportion of patients. The chest radiograph is characteristic, showing features typical of multiple septic pulmonary emboli. The radiograph shows multiple, small, fuzzy, patchy, peripherally located densities that can change rapidly on serial films. Complications of right-sided endocarditis include pulmonary infarction, pulmonary abscess, progressive right-sided heart failure, and renal abnormalities. The treatment of right-sided endocarditis includes prolonged therapy, with high doses of IV bactericidal antibiotics. Four weeks of antibiotic therapy is generally required, but newer regimens using combination antibiotic therapy can be successful in sensitive strains of viridans group streptococci and S. aureus. Surgical resection of the tricuspid valve is recommended for organisms that do not respond to initial antibiotic therapy, fungal endocarditis, resistant relapsing organisms, or coexistent infection with S. aureus and P. aeruginosa. The prognosis of right-sided endocarditis is generally favorable when compared with left-sided endocarditis. The prognosis is especially favorable in IV drug abusers infected with S. aureus. Patients infected with fungal organisms, Pseudomonas or Serratia, have a worse prognosis. The presence of significant right-sided heart failure also imparts a worse prognosis.
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PMID:Endovascular infections arising from right-sided heart structures. 173 55

Nineteen patients with infective endocarditis underwent surgery. Congenital heart disease was found in 6 patients, valve disease in 13. Seven patients had history of rheumatism. Congestive heart failure was noted in 17 patients, arterial embolism in 3, and pulmonary infarction in 1. Blood culture was positive in 36.8%, while vegetations were detected echocardiographically in 58.8% of the patients. Selective surgery was performed in 17 patients and emergency operation in the rest two. There was no operative death. Follow-up for 3-109 months after operation showed no evidence of recurrent endocarditis. We suggest that early surgical treatment is mandatory for intractable infective endocarditis if excellent result is expected.
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PMID:[Surgical treatment of infective endocarditis]. 181 20

Three hundred patients submitted to bedside heart catheterization (BHC) from 1973 to 1985 were studied, in order to assess advantages and risks of the procedure. Two-hundred and sixty seven patients (89%) suffered a myocardial infarction (MI) and 146 of them were in functional class (Killip) II, 36 in FC III and 71 in FC IV. Thirty cases were submitted to BHC due to congestive heart failure. BHC was successful in 288 patients (96%) and the wedge pressure (WP) could be measured in 236 cases (78.7%). The WP was less than 18 mmHg in 47.2% of the patients in FC II, in 44.9% of the patients in FC III and in 35.3% of those in FC IV. Minor complications occurred in 33 cases (11.0%); balloon rupture in 12 (4.0%), transient arrhythmias in 11 (3.7%) and lumen obstruction in another 10 cases (3.3%). Forty five patients (15.0%) presented major complications related to the procedure: pulmonary infarction (PI) in 18 cases (6%), phlebitis in 15 cases (5%), sustained arrhythmias in 10 cases (3.3%), pulmonary artery rupture and endocarditis each in 1 case. The mean age between the group of patients with and without complications was similar the maintenance time as greater in the group of patients with complications: 3.4 +/- 0.2 vs 2.7 +/- 0.1 days (p less than 0.05). We concluded that many patients with clinical evidence of heart failure had WP smaller than 18 mmHg, emphasizing the value of the procedure in patients with complicated MI. The maintenance time was associated with the occurrence of complications, mainly PI and phlebitis.
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PMID:[Bedside cardiac catheterization. Advantages and disadvantages]. 260 78

A case of pulmonary infarction secondary to subacute bacterial endocarditis of pulmonary valve which is associated with subpulmonary VSD is presented. The jet stream of blood through the subpulmonary VSD made damage to the pulmonary valve, which may be one of the reasons why subacute bacterial endocarditis was associated with the subpulmonary VSD. Echocardiography of the right-sided valves will be very useful in order to detect the pulmonary valve endocarditis in congenital heart disease presenting with fever.
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PMID:[A case of pulmonary infarction secondary to subacute bacterial endocarditis with subpulmonary VSD]. 273 96

The efficacy of azlocillin + amikacin was compared to ciprofloxacin (with and without amikacin) in 96 rabbits with right-sided endocarditis due to Pseudomonas aeruginosa. Animals received either: no therapy (controls); amikacin (15 mg/kg/day) + azlocillin (400 mg/kg/day); ciprofloxacin (80 mg/kg/day) or amikacin + ciprofloxacin (above dosages). All three antibiotic regimens were significantly more effective than no therapy in reducing mortality (p less than 0.0005), preventing pulmonary infarction (p less than 0.0005) and reducing mean vegetation titers of P. aeruginosa (p less than 0.0005). Also, the three therapy regimens were equivalent in preventing bacteriologic relapse after discontinuing therapy. No development of antibiotic resistance in vivo was observed.
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PMID:In vivo efficacy of azlocillin and amikacin versus ciprofloxacin with and without amikacin in experimental right-sided endocarditis due to Pseudomonas aeruginosa. 294 42

We investigated the efficacy of a potent new antipseudomonal beta-lactam agent, ceftazidime, in a model of right-sided Pseudomonas endocarditis in 72 rabbits. Animals received either: no therapy (controls), amikacin (15 mg/kg/day), ceftazidime (100 mg/kg/day) or amikacin + ceftazidime. Amikacin + ceftazidime was significantly more effective than single-drug regimens in terms of reduction of mortality (p less than 0.01), prevention of pulmonary infarction (p less than 0.05), reduction of mean vegetation titers of Pseudomonas aeruginosa (p less than 0.05-p less than 0.0005), sterilization of vegetations (p less than 0.0005) and reduction in prevalence of bacteriologic relapses after therapy (p less than 0.005). There was no development of resistance in vivo to either amikacin or ceftazidime.
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PMID:Amikacin + ceftazidime therapy of experimental right-sided Pseudomonas aeruginosa endocarditis in rabbits. 393 92

The clinical manifestations, infective microorganisms, underlying diseases, complications and prognosis of infective endocarditis (IE) were studied in 17 current patients. Data were compared with 101 previous cases reported in Japan. Most patients with IE (110/118 = 93.2%) had underlying heart diseases. IE was noted most often in patients with ventricular septal defect (VSD) and tetralogy of Fallot. The incidence of post operative endocarditis was high (29.4% in the present series and 9.0% in the overall series), too. Streptococcus viridans, Staphylococcus aureus and GNB were the most common etiologic agents with incidences of 28.8% (34/118), 25.4% (30/118) and 9.3% (11/118), respectively. Almost half of the deaths from IE were caused by s. aureus. The mortality was 11.9% (14/118) in both series. The death rate from candida albicans was 100%, from s. aureus 33.3% (10/30) and from str. viridans 5.9% (2/34) in both series. Culture negative patients accounted for 11.9% (14/118) in both series. Complications which did not involve the valves were noted in one patient with cerebral emboli and in two patients with pulmonary infarction in the present series. Cerebral emboli phenomena were seen 8 cases of the overall series, 4 of whom died.
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PMID:Infective endocarditis in children. 402 Oct 67

Clinical features and pathological findings were reviewed in 90 postmortem cases of valvular heart disease (VHD) to clarify the problems and limitations of medical management. The clinical features of severe mitral valve disease included congestive heart failure (CHF), with tricuspid regurgitation in many cases, atrial fibrillation, frequent ventricular premature beats, ventricular hypertrophy, cardiomegaly, increased pulmonary arterial pressure and abnormal hepatorenal function. The most common causes of aortic valve disease (AVD) were rheumatic fever and infective endocarditis, and the major causes of death were sudden death and intractable CHF. Autopsy in cases of AVD revealed marked left ventricular hypertrophy and dilatation, vegetations, thickening, adhesion and calcification in the aortic valve. Some patients died of cardiogenic shock due either to severely impaired cardiac function or to associated myocardial or pulmonary infarction. Abrupt onset of embolism was also related to death of the patients. The management of VHD must include the treatment of CHF and arrhythmias and the prevention of embolism. Appropriate timing for surgery and close follow-up by cardiologists is mandatory.
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PMID:Clinical features, problems in medical management and therapeutic planning in severe valvular heart disease. 649 75

Thirty-six hearts of patients who died with indwelling Swan-Ganz catheters in place were prospectively examined to assess the incidence and extent of localized lesions in the right side of the heart. Bland mural thrombosis in the superior vena cava, the right atrium and the pulmonary artery was found in 22 of 36 cases (61%). Patients with catheter periods greater than 2 days had a greater incidence and extent of bland mural thrombosis (79%) than patients with short-term catheterization (41%, p less than 0.01). Anticoagulation had no influence on bland mural thrombosis. Valvular hemorrhage occurred in 31% and aseptic valvular vegetations in 8% of the hearts. No case of infective endocarditis was found. Four of 36 cases (11%) had evidence of pulmonary infarction that appeared to be unrelated to the lesions in the right side of the heart. Endocardial lesions were common complications of indwelling Swan-Ganz catheters but had no significant impact on the clinical courses of the patients.
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PMID:Local complications associated with indwelling Swan-Ganz catheters: autopsy study of 36 cases. 663 32


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