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

The authors analyze the experience of the treatment of eight patients with primary acute septic endocarditis (SE), 35 patients with rheumatic heart disease complicated by secondary subacute SE, 68 patients with early postsurgery SE including 25 who had had closed mitral comissurotomy, and 43 with prosthetic SE. Surgical treatment consisting in the removal of the infection source (the impaired valve or prosthesis) and the implantation of a new prosthesis should be carried out before the development of irreversible alterations of the internal organs.
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PMID:[Septic endocarditis in cardiosurgical clinical practice]. 638 15

A survey of hospitalizations at the Chaim Sheba Medical Center, covering two nonconsecutive decades (1951-60 and 1970-79), included 213 patients (228 episodes) with infective endocarditis. The increase in the age of patients and in the frequency of atherosclerotic heart disease, as well as the introduction of techniques such as heart catheterization and open-heart surgery, are responsible for the differences in clinical course, microbiology and therapy. Despite the changed pattern, rheumatic heart disease remained the principal underlying disease in both periods and Streptococcus viridans remained the most common pathogen. Not a single case of drug addiction appeared in our material, despite its increasing frequency in Israel.
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PMID:A comparative study of infective endocarditis. 646 57

A case of endocarditis caused by Salmonella typhi is reported in a 24-year-old Egyptian woman known to have rheumatic heart disease. The diagnosis was confirmed by positive blood cultures and echocardiogram.
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PMID:Endocarditis due to Salmonella typhi. 661 84

Fifty-two cases of apparent endocarditis prophylaxis failure were reported to a national registry established by the American Heart Association (AHA). Mitral valve prolapse was the single most common underlying cardiac lesion (17 cases, 33%), followed by various congenital abnormalities (15 cases, 29%) and rheumatic heart disease (11 cases, 21%). Ten patients (19%) had prosthetic valve endocarditis. Forty-eight cases (92%) occurred after a dental procedure. Symptoms began within two weeks after the procedure suspected to have caused endocarditis in 50% and within five weeks in 79%. Thirty-nine cases (75%) were caused by viridans streptococci and seven (14%) by Staphylococcus aureus. Most patients received oral penicillin as prophylaxis. Only six patients (12%) received regimens currently recommended by the AHA. In 27 (63%) of the 43 cases for which antimicrobial susceptibility data were available, the infecting microorganism was sensitive to the antibiotic(s) used for prophylaxis. After diagnosis of endocarditis, the prognosis for bacteriologic cure was good; 47 patients (90%) were cured, of whom seven underwent valve replacement. These data indicate that endocarditis prophylaxis failures may be more common than was previously believed and that failures occur even when the infecting organism is susceptible to the antibiotics used. Most antimicrobial regimens used in patients with prophylaxis failures did not conform to current recommendations.
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PMID:Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry. 663 28

Three hundred and seventy nine patients who had undergone mitral valve replacement using unstented antibiotic sterilised aortic homografts were followed up for 52 to 138 months (mean 102 months). Patients requiring additional aortic valve replacement were excluded. The commonest cause was rheumatic heart disease (321 patients). There were 37 early deaths (9.8%) and 97 late deaths (28%). The actuarial survival of operative survivors was 83% at three years, 75% at five years, and 55% at nine years. Technical valve failure occurred in six patients (1.6%), infective endocarditis in 19 (5%), and degeneration of the valve in 43 (12.5%). The cumulative probability of freedom from endocarditis was 96% at three years, 94% at five years, and 91% at nine years, while that of freedom from valve degeneration was 97% at five years and 48% at 10 years. There were no early embolic episodes, but late embolism occurred in five patients (1.5%).
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PMID:Late results of mitral valve replacement using unstented antibiotic sterilised aortic homografts. 665 99

Ninety patients who underwent emergency cardiac valve surgery from January 1976 to December 1981 are reported. Patients were divided in two groups: those operated on native valves are included in group I; patients with prosthetic valves operated because of leakage or malfunction, in group II. In group I (57 patients) the aetiology was: rheumatic heart disease (34 cases); acute endocarditis (16 cases); sequelae of recent endocarditis (2 cases); luetic infection (1 case); sequelae of myocardial infarction (1 case); rupture of mitral chordae in mixomatous valve (3 cases). The emergency operation was prompted in 22 patients by cardiogenic shock, in 13 patients by intractable pulmonary edema, in 21 patients by low output syndrome, in one case by ventricular arrhythmias. In group II (33 cases) the causes of reoperation were: in 27 cases leakage (in 13 due to active endocarditis); in 6 cases variance of the occluder or thrombosis. The emergency originated in 12 cases from cardiogenic shock, in 11 cases from intractable pulmonary edema, in 9 cases from low output syndrome, in 1 case from ventricular arrhythmias. Twenty-six patients died perioperatively in group I and 17 in group II. Mean follow-up in group I was 26 months. Among 27 patients there were two deaths; 25 patients are alive and well (one has been reoperated again). Mean follow-up in group II was 21 months. Among the 15 patients observed there were 6 deaths (3 after re-reoperation); 9 patients are alive and well (one has been re-reoperated).' The Authors feel that surgery is mandatory in all such patients to ensure satisfying long term results, in spite of high perioperative mortality rate.
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PMID:[Emergencies in valvular surgery]. 667 91

To assess the reliability of M-mode echocardiographic patterns of mitral valve prolapse (MVP) (echo MVP) in detection of morphologic evidence of MVP (morphologic MVP), operatively excised mitral valves and corresponding M-mode echocardiograms from 65 patients with chronic, severe, isolated, pure mitral regurgitation (MR) were studied. Of the 65 patients, 45 (69%) had echo MVP (either holosystolic or mid-to-late systolic prolapse patterns on preoperative M-mode echograms) and 42 (93%) of them had morphologic MVP; of the 3 without morphologic MVP, 2 had ruptured chordae tendineae from infective endocarditis and 1 had papillary muscle dysfunction from atherosclerotic coronary heart disease. Of the 20 patients without echo MVP, 14 (70%) had no morphologic MVP (9 had papillary muscle dysfunction from coronary heart disease, 4 had infective endocarditis on previous normal valves and 1 had rheumatic heart disease). Of the 48 patients with morphologic MVP, 42 (88%) had echo MVP and most had considerably dilated mitral anulae; the other 6 had ruptured chordae tendineae with less degrees of anular dilatation. Of the 17 patients without morphologic MVP, 3 had echo MVP (coronary artery disease in 1 and infective endocarditis on a previous normal valve in 2); of the 14 with neither echo nor morphologic MVP, 9 had papillary muscle dysfunction from coronary artery disease, 4 had infective endocarditis on previously normal valves and 1 had rheumatic heart disease. The patients with very dilated mitral anuli and leaflet areas generally had holosystolic (hammocking) patterns on echo; the patients with small anuli and leaflet areas usually had mid-to-late systolic (buckling) prolapse patterns.
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PMID:Frequency and significance of M-mode echocardiographic evidence of mitral valve prolapse in clinically isolated pure mitral regurgitation: analysis of 65 patients having mitral valve replacement. 669 Dec 50

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

Mitral valve prolapse (MVP) now is a commonly recognized syndrome with an apparent prevalence of approximately 4-6%. It appears to occur more frequently in females and occasionally it is familial. In most instances, the syndrome is idiopathic, although it occurs in association with many other conditions, particularly Marfan's syndrome, rheumatic heart disease, coronary heart disease, congestive cardiomyopathy, ostium secundum atrial septal defect, Ehlers-Danlos syndrome or abnormalities of the thoracic cage. The majority of patients with the syndrome have minimal, if any, symptoms and have a benign course. When symptoms do occur, more frequently they are palpitations, chest pain, dyspnea on exertion or fatigue. Neuropsychiatric symptoms or even transient ischemic episodes may occur rarely. Very rarely, complications such as severe mitral regurgitation, arrhythmias or infective endocarditis may occur. Characteristically, patients have a midsystolic click, occasionally followed by a systolic murmur. The timing of the click and the onset of the murmur usually is variable, depending on the ventricular volume. The electrocardiogram frequently shows ST-T wave changes. The diagnosis usually can be confirmed by echocardiography or left ventricular angiography. Most patients with MVP require no treatment other than reassurance. If a systolic murmur is present, prophylaxis against infective endocarditis during dental work probably is useful. Patients with palpitations or chest pain usually respond well to treatment with propranolol. Patients with progressive severe mitral regurgitation require mitral valve replacement.
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PMID:Mitral valve prolapse. 699 66

A 42 year old man without history of rheumatic heart disease was admitted to the hospital with severe aortic insufficiency and heart failure. There were no clinical data of an infectious disease. The bidimensional echocardiogram showed vegetations involving the aortic valve leaflets. With the diagnosis of acute aortic insufficiency caused by infective endocarditis the patient was submitted to surgery. During surgery the existence of endocarditis secondary to a mycotic agent was demonstrated. The fungus was latter identified as aspergillus fumigatus. The postoperative course was uneventful. The good results obtained in this case confirm recent reports advising an urgent surgical approach of cases of infective endocarditis secondary to mycotic agents, and support the view that echocardiography may be a valuable tool in the diagnosis of this entity.
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PMID:[Aspergillus endocarditis. Report of a case treated surgically with success]. 703 62


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