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

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

Medtronic-Hall valves were implanted during 204 procedures performed between 1982 and 1988. Mean population age was 54.4 years; 96% of patients were in New York Heart Association functional class III or greater. Emergency operations constituted 16% of the procedures. Rheumatic heart disease was the single most common indication for valve replacement. In 18% of patients, operation was performed to replace a previous prosthetic valve. The mean follow-up was 3.2 years. Overall operative mortality was 10.3%, the highest mortality being for double-valve replacements (24%). Valve-related mortality, by position, was 5.3% for aortic valves, 6.0% for mitral valves, and 4.0% for multiple-valve replacements. Actuarial 5-year freedom from events were: survival, 68%; thromboembolism, 90%; prosthetic valve endocarditis, 98%; paravalvular leak, 95%; and reoperation, 92%. Complications with the highest mortality were thromboembolism (36%) and endocarditis (33%). The complication rates in this series are high but the patients were more severely ill than in other reports, and operative survivors experienced a considerable improvement in New York Heart Association functional class.
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PMID:Clinical experience with the Medtronic-Hall valve prosthesis. 157 Oct 8

In a five-year prospective study of blood culture-positive septicaemia in a Hong Kong teaching hospital there were 2211 clinically-significant episodes, of which 16% occurred in children less than 15 years old. The microbiology and clinical features were broadly similar to those seen in Europe and North America, but with some important differences. Two-thirds of episodes were community-acquired. The most common organism isolated from community-acquired septicaemias was Escherichia coli and the source, most commonly, the urinary tract. However, the biliary tract was the second most common source of community-acquired infection (25%), reflecting the frequency of liver disease in Hong Kong. Three per cent of community-acquired septicaemias were associated with endocarditis; half of these were with viridans streptococci, usually in patients with rheumatic heart disease, and 40% were in drug addicts with methicillin-sensitive Staphylococcus aureus. The commonest organisms causing community-acquired childhood infections were Salmonella spp. (27%) and Streptococcus pneumoniae (22%), whereas pneumococci accounted for only 3% of adult community-acquired micro-organisms. Haemophilus influenzae infections were uncommon and there was no case of meningococcal or gonococcal septicaemia. The commonest cause of hospital-acquired septicaemia was Staph. aureus (24%), of which 46% were methicillin-resistant. The characteristics of septicaemia in Hong Kong are influenced by the patient population structure, endemic disease patterns, local medical practice and socio-economic factors, but the rarity of Str. pneumoniae in adults and of H. influenzae and Neisseria meningitidis in children is unexplained.
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PMID:Septicaemia in Hong Kong. 234 72

We describe the pathologic findings at autopsy in 96 persons who had undergone prosthetic heart valve implantation. The most common indication for implantation was rheumatic heart disease (58%), followed by infective endocarditis (22%). Cardiac failure led to death in two thirds of the cases, most often from infective endocarditis (18%) and congestive heart failure (13%). Failure of the prosthetic valve caused death in eight cases. There were 13 deaths intraoperatively or in the immediate postoperative period. Patients with mechanical prostheses survived longer than did those with bioprostheses. The most common prosthesis-related complication was thrombosis, found in 23% of mechanical valves and 11% of bioprostheses. Thrombosis led to death in only 4 cases. Thromboembolic phenomena led to nine deaths and were not related to anticoagulant therapy. These findings provide an approach to investigation, description, and diagnosis of prosthetic heart valves at autopsy.
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PMID:Cardiac valve prostheses at autopsy. 239 9

The frequency of mitral valve prolapse was assessed in 48 patients with mitral valve endocarditis and in 96 controls matched for age and sex, attending a routine family screening clinic or having surgery of the limbs. The frequency of mitral valve prolapse in cases with endocarditis (9 of 48 patients) was more than three times that in controls (6 of 96) (odds ratio 3.5; 95% confidence interval [CI] 1.1-10.5). When patients with rheumatic heart disease, an established risk factor for infective endocarditis, were excluded from the study group, patients were nearly six times more likely to have infective endocarditis than were controls (odds radio 5.7; 95% CI 1.8-18.4). However, a higher risk of infective endocarditis was seen only in the subjects with mitral valve prolapse and a previously known systolic murmur (odds ratio 14.5; 95% CI 1.7-125). The results indicate that mitral valve prolapse constitutes a true risk factor for infective endocarditis only when associated with the presence of a precordial systolic murmur.
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PMID:Mitral valve prolapse as a risk factor for infective endocarditis. 257 95

Thirty cases of infective endocarditis identified in the autopsy service of the University Hospital over a 10-year period are reviewed. The mean age of the patients was 30.6 years, and 70% were below the age of 40 years. Sixty per cent of the cases had previous heart disease of which rheumatic heart disease was the most common. Degenerative heart disease and floppy mitral valve contributed one case each. The mitral valve was most commonly affected, and there were only 2 cases of right-sided endocarditis. Evidence of systemic embolization was present in 83% of the patients. The results of this study are compared with others from both developed and under-developed countries.
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PMID:Infective endocarditis at the University Hospital of the West Indies. A postmortem evaluation. 262 45

Eighty opiate addicts were studied at necropsy. Fifty-nine patients had anatomic evidence of active infective endocarditis (IE); 11 had healed IE; and 10 had both. Of the 80 patients, the first episode of IE involved a single right-sided cardiac valve in 24 patients (30%); both a right- and a left-sided valve in 13 patients (16%); a single left-sided valve in 33 patients (41%); and both left-sided valves in 10 patients (13%). Of the 320 cardiac valves in the 80 patients, 103 were sites of vegetations, an average of 1.3 of the 4 valves. Of the 80 patients, the tricuspid valve was infected in 35 (44%), mitral in 34 (43%), aortic in 32 (40%) and pulmonic in 2 (3%). Of the 103 infected cardiac valves, the infection caused sufficient damage to cause dysfunction in 70 (68%): in 28 (88%) of 32 infected aortic valves; in 22 (63%) of 35 infected tricuspid valves; in 19 (56%) of the 34 infected mitral valves; and in 1 of the 2 infected pulmonic valves. Of the 80 patients, 57 (71%) had sufficient valvular damage to cause valvular dysfunction. Of the 80 patients, gross examination of the valves at necropsy indicated that the infected valve almost certainly had been anatomically normal in 65 patients (81%) and abnormal in 15 patients (19%) before the onset of IE. Of the 65 patients with previously anatomically normal valves, 86 (33%) of their 260 cardiac valves were sites of infection (average 1.3 valves/patient); of the 15 patients with infection superimposed on a previously abnormal valve, the infection in each involved previously abnormal valves (21 in the 15 patients) or 17 (28%) of their 60 cardiac valves were sites of infection (average 1.1 valve/patient). Of the 15 patients with abnormal cardiac valves before the infection, 7 had congenitally bicuspid aortic valves and 8 had diffuse fibrous thickening of the mitral valve typical of rheumatic heart disease with (6 patients) or without (2 patients) diffuse fibrous thickening of tricuspid aortic valves. Of the 80 patients, 42 (53%) died during their first episode of active IE, 17 (21%) underwent operative excision with or without valve replacement during the active IE, and in 21 patients (26%) the first episode of active IE healed. In 10 of the latter 21 patients, active IE recurred and was fatal. A total of 19 patients had cardiac valve excision with or without replacement, 17 during active IE and 2 after healing.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Infective endocarditis in opiate addicts: analysis of 80 cases studied at necropsy. 271 95

The pattern of cerebrovascular disease in North-West India has been studied in a necropsy series of 362 cases over a 14 year period. One hundred and thirty eight cases of intracranial haemorrhage were found, 89 of cerebral embolism, 101 of cerebral arterial thrombosis and 34 of cerebral venous thrombosis. Nearly 37% of the affected patients were below 40 years of age. Cerebral embolism and cerebrovenous thrombosis were important causes of stroke in the young. Rheumatic heart disease and infective endocarditis formed the major causes of cerebral embolism. Cerebral venous thrombosis associated with pregnancy and puerperium was relatively more common in our series than has been reported in the West.
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PMID:Cerebrovascular disease in north-west India: a study of necropsy material. 273 94

Over a 10 year period, 78 cases of infective endocarditis were seen at a general hospital serving a multiracial community. There was a bimodal distribution by age and by race. Rheumatic heart disease was a predisposing factor in 45% of cases and was particularly common in young Polynesians. Only eight patients had undergone procedures which might have caused bacteraemia. Most cases were due to streptococci (67%) or staphylococci (27%). Eighteen of 78 patients (23%) died in hospital, usually as a result of overwhelming sepsis or neurological complications. The 60 discharged have been followed for an average of almost three years. There have been 11 deaths but only two related to the previous endocarditis. Three of 41 patients infected with viridans streptococci died. There were no relapses and only one microbiological failure due to these organisms. All 14 patients with viridans streptococcal endocarditis treated with combined therapy for two weeks were cured. Ten of 16 cases of Staph aureus endocarditis were fatal. All but one involved the left side of the heart. The series included no intravenous drug abusers. Sixteen cases of endocarditis involved prosthetic valves and in this group the mortality, frequency of complications and need for surgery were significantly more frequent than in those with native valve infection.
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PMID:Infective endocarditis in a racially mixed community: a 10 year review of 78 cases. 273 64

Between December 1985 and June 1987, 38 consecutive patients with mitral regurgitation underwent mitral valve reconstruction (MVP) with Carpentier rings. There were 16 men and 22 women, ranging in age from 16 to 63 years (mean 36.4 +/- 14.4). The underlying causes were rheumatic heart disease (55%), degenerative valvular disease (42%), and congenital heart disease (3%). Thirty patients were categorized in the New York Heart Association's functional classification III or IV preoperatively. The concomitant procedures included aortic valve replacement (AVR) in 6 patients, tricuspid valve repair (TVP) in 9, and closure of atrial septal defect in one. Hospital death happened to one patient (3%). All but one patient were followed up at 31 months postoperatively (rate 98.6%). There was one late death due to myocardial failure not related to the valves. The actuarial survival rate at 31 months was 96.8%. The thromboembolic rate was 1.44% per patient-year. No reoperation or endocarditis was encountered. All 36 survivors were in functional classes I and II. Twenty-one patients underwent Doppler echocardiography 3 to 12 months after surgery and 17 (81%) showed no or mild mitral regurgitation and 4 (19%) had moderate regurgitation. We conclude that MVP with Carpentier rings is a satisfactory method with low mortality and complication rates in Chinese patients.
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PMID:Mitral valve reconstruction with Carpentier ring for mitral regurgitation: experience with Chinese patients. 279 33


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