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

Calcification in the wall of the left atrium is a certain sign of rheumatic heart disease; in nearly all cases it is associated with combined mitral valve disease and auricular fibrillation. The cause of the calcification is probably repeated attacks of endocarditis. Similar to the cases described in the literature, four out of five our own patients were in the end-stages of chronic rheumatic heart disease. In four patients there was clinical evidence of mitral valve disease, whereas in the fifth patient, the clinical findings suggested a ventricular septal defect. Calcification in the dilated left atrium indicated the presence of an additional mitral valve abnormality. The typical appearances of atrial calcification are illustrated. The importance of its pre-operative demonstration is discussed on the basis of the relevant literature.
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PMID:[Calcification of the left atrium in mitral disease]. 12 55

We have encountered two cases of late calcification of the porcine heterograft. A patient in chronic renal failure died of sepsis and endocarditis fifteen months after replacement of the mitral and tricuspid valves. At postmortem examination, both heterograft valves exhibited severe calcification and thrombosis. A second patient with rheumatic heart disease and sickle cell disease underwent mitral valve replacement for severe regurgitation. Thirty months later, cardiac catheterization revealed prosthetic valve stenosis. The valve was replaced successfully, and the excised heterograft exhibited severe calcification with restriction of leaflet motion. Although calcification of the porcine heterograft is known to occur in patients with infection or disorders of calcium metabolism, dysfunction of the heterograft is rare in our experience.
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PMID:Calcific stenosis of the porcine heterograft. 45 40

Twenty-six cases of infective endocarditis seen at autopsy during the first decade of life, between 1911 and 1944, are compared with seven fatal cases between 1944 and 1977. The incidence of infective endocarditis at autopsy in this age-group has decreased since 1944 (0.60% to 0.23%). Before 1944, Gram-positive cocci were most frequently responsible. Rheumatic heart disease (31%) more often predisposed to infective endocarditis than did congenital heart disease and left-sided valves were most frequently involved. Peripheral septic foci and penumonia were the most frequent sources of infection. The introduction of penicillin and advances in cardiology and cardiovascular surgery have had considerable impact of the spectrum and evolution of the diseases. Fungi and uncommon opportunistic bacteria are now frequently encountered. Rheumatic heart disease rarely predisposes to infective endocarditis in this age-group, congenital heart disease being the major underlying disease.
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PMID:Infective endocarditis during the first decade of life. An autopsy review of 33 cases. 58 87

The features of 70 cases of bacterial endocarditis are reported. Streptococcus viridans was the cause in 45 per cent, staphylococci in 27 per cent, and enterococci in 7 per cent. Rheumatic heart disease was the predisposing factor in less than one quarter of patients and in almost half there was no obvious pre-existing cardiac disease. Apart from cardiac murmurs and pyrexia, the classical features of infective endocarditis were uncommon, haematuria being observed in less than one-third. Most patients were over the age of 30, one-third more than 60 years of age and the peak incidence occurred in the seventh decade. The mortality was 34 per cent, being highest in infection caused by Staphylococcus aureus. Adverse prognostic features included cardiac failure, advanced age and peripheral embolization. One-third of infections were caused by bacteria resistant to penicillin.
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PMID:Bacterial endocarditis in England in the 1970's: a review of 70 patients. 59 99

A 61-year-old man with Trichosporon cutaneum (T. cutaneum) prosthetic valve endocarditis is reported. He had had an aortic valve replacement for rheumatic heart disease 3 years earlier. Onset of the valve infection was subacute. A systolic murmur was noted on admission. Subsequently, he developed conjunctival hemorrhages, hematuria and transient episodes of confusion, aphasia and cranial nerve palsies. Three of 17 blood cultures taken over 3 weeks were positive for T. cutaneum. He was given amphotericin B (AmB) and 5-fluorocytosine (5FC); T. cutaneum infection of prosthetic aortic valve was identified. The aortic valve was replaced. Postoperatively he developed refractory ventricular fibrillation and died. Striking synergy to AmB-5FC and AmB-rifampin combinations was demonstrated in vitro.
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PMID:Trichosporon cutaneum endocarditis. 71 85

Prophylaxis is defined as: "measures designed to preserve health and prevent the spread of disease" (18). Two implicit parts to such a definition are first, that what is being prevented causes disease, and second, that the measure(s) proposed prevents this disease. We will briefly review the evidence that patients with rheumatic heart disease and/or prosthetic cardiac devices are at increased risk of morbidity and mortality from infection and further that antibiotics reduce this morbidity and mortality. Antibiotic prophylaxis is undertaken in patients with rheumatic heart disease and in those with prosthetic devices for two purposes: 1. prevention of reccurrences of rheumatic fever; and, 2. prevention of infective endocarditis. These are two different issues which will be discussed separately.
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PMID:Antibiotic prophylaxis in patients with rheumatic heart disease and prosthetic devices. 75 16

Twenty-six major cardiovascular centers participated in a cooperative study of all cases of infective endocarditis occurring during a single calendar year to obtain an overview of infective endocarditis. The study was designed to learn which patients appear to be at highest risk to develop this infection after palliative or reparative cardiovascular surgery. Of 278 patients developing infective endocarditis during the year at these medical centers, 63 (23%) had had previous cardiovascular surgery and 215 had not. Seventy percent of the 278 patients had recognized congenital or acquired heart disease before developing the infection. Rheumatic heart disease accounted for over half of the patients with underlying structural heart disease. A majority (55%) of the 63 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of those who did not require prosthetic valves, the majority had congenital heart disease with systemic artery-to-pulmonary artery shunts. Although these data were obtained from a selected group of patients, they confirm a significant risk of endocarditis in patients with prosthetic valves and suggest that in postoperative patients with non-valvular congenital heart disease, the highest risk appears to be in cyanotic patients with palliative pulmonary artery-to-systemic artery shunts.
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PMID:A collaborative study of infective endocarditis in the 1970s. Emphasis on infections in patients who have undergone cardiovascular surgery. 75

This is the first reported case of fungal endocarditis due to vegetative growth of Phialophora mutabilis on a prosthetic mitral valve. The patient had rheumatic heart disease with mitral and aortic stenosis. Four months after the mitral and aortic valves had been replaced by prostheses the patient developed congestive failure. Because of increased left atrial pressure, the mitral prosthesis was replaced. A large matted obstructive fungal vegetation was found on the prosthesis. Culture of this vegetation grew Phialophora mutabilis. The patient died postoperatively, and at autopsy the fungus was not found in other tissues. Culturally and morphologically, P. mutabilis shows wide variation in pigmentation, colonial and microscopic appearance. Conidia formation from intercalary cells along the hyphae is somewhat similar to that of Aureobasidium spp. P. mutabilis was injected into mice. Mice pretreated with cortisone died 3 to 5 weeks after intraperitoneal inoculation, while the majority of untreated mice died within 20 weeks of inoculation.
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PMID:Phialophora mutabilis endocarditis. 80 42

Atrial fibrillation is rare in children. Previous reports associated it with severe rheumatic heart disease and a poor prognosis. This review is of the unique experience of 35 cases of atrial fibrillation in children in the past 22 years; 23 patients were boys. The age of onset ranged from 1 day to 19 years (average, 8 years). Associated cardiac conditions were severe rheumatic mitral regurgitation (3 cases), cardiomyopathy (5), atrial tumors (2), infective endocarditis (1), paroxysmal atrial tachycardia of infants (4), idiopathic paroxysmal atrial fibrillation (1), Marfan's syndrome with mitral regurgitation (1), endocardial fibroelastosis (1), and structural congenital heart malformations (17). Surgical correction of congenital heart lesions was directly related to the development of atrial fibrillation in 14. Varying arrhythmias of the sick-sinus syndrome were observed in five children. The atrial fibrillation was paroxysmal or transient in 21 patients and persistent in 14. Treatment depended on the underlying condition. Digoxin was used in all cases and cardioversion attempted in ten; no patient was given anticoagulants. Three children had cerebral emboli, with residual defects. Eighteen patients are known to be alive, 13 are dead, and 4 are lost to follow-up. Atrial fibrillation in childhood is an indication for complete investigation of the patient and for the institution of treatment appropriate to the underlying disease.
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PMID:Atrial fibrillation in children. 83 8

Ninety cases of infective endocarditis seen over a 10-year-period at University College Hospital, Ibadan, are reviewed. The peak incidence was in the third decade and rheumatic heart disease was the commonest pre-existing lesion in 59 cases with subacute endocarditis. In most cases the source of infection was not known. In 41 of the 90 cases (44%) the diagnosis was made only at autopsy. The bacterial isolation rate was low, the commonest organisms being staphylococci, streptococci, micrococci and gramnegative bacilli. The overall mortality was 70%. A plea is made for increasing awareness of the disease and prompt institution of effective treatment.
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PMID:Infective endocarditis-experience in Nigeria. 94 Dec 46


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