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

Forty-one patients with infective endocarditis were treated surgically at the University of Alberta Hospital, Edmonton, between 1961 and 1980. Their ages ranged from 10 to 67 years and the male to female ratio was 4:1. A wide variety of organisms were cultured but gram-positive organisms predominated. Bicuspid aortic valves, normal valves and valves affected by rheumatic heart disease, were the most common sites of infection. The aortic valve was most frequently involved. The onset of left ventricular failure was the major indication for surgery. The overall mortality at 30 days was 19.5%. The mortality after 30 days was 9.8%. Eleven of 12 patients who died had left ventricular failure preoperatively. The mortality in patients who had valve replacement during the first 4 weeks of infection did not differ from those who had valve replacement after 4 weeks of infection. Hemodynamic studies following operation in six patients showed that pulmonary arterial and wedge pressures had returned to normal levels. Nineteen of 26 patients who were followed up were asymptomatic. One had a malfunctioning prosthesis, one chronic heart failure and one had reoperation for paravalvular leak. Four patients diet during the follow-up period. The authors conclude that all patients with infective endocarditis who suffer left ventricular failure should have prompt valve replacement regardless of the duration of antibiotic therapy.
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PMID:Infective endocarditis: surgical treatment of 41 patients. 706 73

Three hundred eighty-seven pregnancies (295 patients) complicated by maternal heart disease, managed at the National Maternity Hospital, Dublin, Ireland, during the years 1969 to 1978, were reviewed. The incidence was 0.5%. Three hundred twenty-three (83.5%) were of rheumatic origin, 52 (13.4%) were congenital, and the remaining 12 (3.1%) were a miscellaneous group and included cases of cor pulmonale and coronary artery disease. There were two maternal deaths--one from congenital heart disease and one from postpartum suicide, unrelated to mild rheumatic heart disease. The perinatal mortality rate was 3.3%. Five pregnancies (three patients) were complicated by surgically uncorrected cyanotic congenital heart disease. One of the maternal deaths and three of the perinatal deaths occurred in this group. There were 38 episodes of cardiac failure (38 patients) in cases of rheumatic heart disease. The New York Heart Association grading was grade 1 in 15 (39%) of these before the onset of failure. Prophylactic antibiotics were not used and infective endocarditis did not occur. Therapeutic abortion was not practiced and a conservative approach was adopted in obstetric intervention and in all drug therapy.
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PMID:Pregnancy complicated by maternal heart disease at the National Maternity Hospital, Dublin, Ireland, 1969 to 1978. 745 8

During the past 2.5 years, 50 Ross operations have been performed at Rigshospitalet in Copenhagen in a broad range of patients with aortic valve disease including children and adults from 6 weeks to 71 years of age. Many patients had complicating conditions including endocarditis (n = 13, eight native, five prosthetic valve), prosthetic valve dysfunction (n = 4), subvalvular obstruction (n = 3) treated by septal myectomy (n = 1) or modified Konno operation (n = 2), ascending aortic aneurysm (n = 2), ventricular septum defect (n = 1), mitral valve disease (n = 6), rheumatic heart disease (n = 4), coronary artery disease (n = 1), and extreme obesity (n = 1). All operations were performed as free-standing total aortic root replacements. The results have been encouraging with low mortality (2%) and no major morbidity. One patient has been reoperated because of autograft insufficiency due to left coronary cusp prolapse and two additional patients have grade 2 autograft insufficiency and are being followed closely. Two patients have developed early pulmonary homograft stenosis, which has required pulmonary homograft replacement. Despite these problems, we are enthusiastic about this operation and believe it may emerge as operation of choice for most patients under 60-65 years of age with aortic valve disease and for patients with prosthetic or advanced native aortic valve endocarditis. With increasing frequency, our choice has been to proceed with a Ross operation, and currently, our only absolute contraindication is Marfan's syndrome. Based on reported recurrent disease in patients with rheumatic valve disease, the autograft should be used with caution for this indication.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Expanding indications for the Ross operation. 758 41

A retrospective study of 69 cases of infective endocarditis in 68 children (group I: 1971-1981; 34 children; group II: 1982-1992; 34 children) disclosed the following features: a moderate increase in the global incidence of infective endocarditis (0.5% of children hospitalized in paediatric cardiology units) and of its incidence in the very young (proportion of children less than 1 year of age: 9% in group 1 and 17% in group II); no rheumatic heart disease amongst predisposing heart diseases in children living in France; a major causal role of congenital heart diseases (72%), with an increasing incidence of previous operation (group I: 42%; group II: 56%); an increase in associated complex congenital heart diseases (group I: 11%; group II: 20%); no change in related mitral valve prolapse (5% in both groups); positive blood cultures in 76% of cases, with similar rates of Staphylococci (group I: 27%; group II: 30%) and of unusual microorganisms (15% in both groups); a major diagnostic role for echocardiography (vegetations in group II: 64%). Complications occurred in 75% of cases in both groups (pulmonary or systemic emboli, mycotic aneurysms, valvar regurgitation), leading to heart failure in 29% of group I patients and in 32% of group II patients. Mortality has decreased, from 12% in group I to 3% in group II, as a result of more frequent cardiovascular surgery (group I: 11 cases; group II: 15 cases), problems due to restrictive prostheses, and severe consequences: only 27% of group II children were cured without deterioration of their cardiac condition.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changing patterns and prognosis of infective endocarditis in childhood. 767 21

With the object of studying the profile of infective endocarditis in Indian children younger than 16 years of age, a retrospective study of 37 patients with infective endocarditis admitted to this hospital between January 1984 and December 1990 was carried out. There were 26 boys and 11 girls (aged 2-16 years (mean (SD) 10.3 (3.8)). Eighteen (48.6%) patients had underlying congenital heart disease, 13 (35.1%) had associated rheumatic heart disease whilst the remaining six had no pre-existing heart disease. All six patients with a normal heart and infective endocarditis had preceding extra-cardiac bacterial illnesses (epididymitis and orchitis in one, pneumonia in five). Blood cultures were positive in only 16 (43.2%): Staphylococcus aureus was grown in nine, Streptococcus viridans in six and Candida albicans in one. Sixteen (43.2%) of the 37 patients died owing to worsening cardiovascular haemodynamics, uncontrolled septicaemia and our inability to offer emergency surgery. The profile of infective endocarditis in developing countries is different from that in Europe and the United States of America, and the disease carries a very high mortality.
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PMID:Infective endocarditis in children: profile in a developing country. 768 16

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

From May 1990 to January 1994, 120 patients underwent aortic valve replacement with the use of the Biocor porcine aortic stentless heart valve (BPASHV). There were 83 male and 3 female patients. The age ranged from 11 seventy-six (76) years with a mean of 36. Eighty-five patients were under 40 years of age. Sixty-four patients underwent their first aortic valve replacement due to rheumatic heart disease, 30 because of prosthetic valve failure and of those: 20 were due to primary tissue failure and in 10 due to prosthetic endocarditis, native aortic bicuspid valve in 11 and senile calcificant aortic valve disease in four. Thirty-three patients had aortic annular related pathology. Their preoperative functional class revealed 61 patients in class III and 59 in class IV. The longest follow-up in this aortic group was 42 months with a mean of 26. The surgical technique used rendered consistent and reproducible results. There was a hospital mortality of six patients (5%). The mortality was not valve related. The hospital morbidity in 14 revealed full recovery of all patients. There were four late reoperations, in two due to recurrent endocarditis and in the last two because of paravalvar leak. There was a late mortality of four patients (non valve related). The follow-up of these patients revealed full competent aortic stentless valve in 97 patients and only minor jet in nine. Most patients are in functional class I and II. The Aortic stentless concept has proven to be outstanding with the use of the Biocor Aortic stentless valve throughout the current follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Porcine stentless aortic heart valve substitute mid-term clinical follow-up. 777 52

Beginning March 1992 to February 1994, 65 patients were submitted to mitral valve replacement using the porcine mitral stentless heart valve. This group took in 65 patients, their age ranged from four to 65 with a mean of 26 years. Forty patients were below years of age. The major indication was rheumatic heart disease sequelae in 50 patients, mitral valve endocarditis in six, myomatous degeneration in four and in five previous mitral prosthetic valve was replaced due to tissue failure. The preoperative functional class revealed 35 patients in class III and 30 in class IV. The longest follow-up was 23 months with a mean of 12. The surgical technique used rendered consistent and reproducible results. There was a hospital mortality of two patients or 3.1%. The hospital morbidity revealed full recovery of all patients. There were three patients reoperated because of valve endocarditis in two and in one due to partial dehiscence of the suture at the annular level. All three patients had full recovery after a reoperation. There was a late mortality of two patients, non valve related. The follow-up of these patients revealed full competent stentless mitral valve in 50 patients and in nine minor to mild jets were encountered by color echo-Doppler. Most patients are in functional class I and II. The stenless concept has prove to be outstanding in the mitral position throughout the current follow-up of close to 2 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Porcine stentless mitral heart valve substitute: short term clinical data. 777 54

Acquired heart disease in children may result in significant morbidity and mortality. Advances continue to be made in understanding Kawasaki disease, acute and chronic rheumatic heart disease, infective endocarditis, myocarditis, and dilated cardiomyopathy. The role of superantigens, particularly bacterial toxins, in the pathogenesis of Kawasaki disease continues to be defined. Intravascular ultrasound promises to improve the assessment of coronary arteries in Kawasaki disease. Current recommendations for the long-term management of Kawasaki disease are discussed. Significant changes in the epidemiology of acute rheumatic fever and endocarditis are noted. Updates on the role of echocardiography as well as current therapeutic issues in these diseases are addressed. The application of immunologic and molecular biologic techniques have implicated genetic and immune factors in the pathogenesis of myocarditis and cardiomyopathy. The relationship between viral infection and subsequent dilated cardiomyopathy, as well as the role of autoimmune mechanisms in the pathogenesis of these disorders, remains controversial.
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PMID:Advances in acquired pediatric heart disease. 778 68

The prevalence of left atrial spontaneous echo contrast (SEC) and the occurrence of systemic embolism were prospectively studied in 176 consecutive patients. All had significant mitral regurgitation (MR) and underwent transesophageal echocardiographic (TEE) studies. Left ventriculography was performed in all patients to document the severity of MR. The underlying causes of MR included rheumatic heart disease in 84 patients, ruptured chordae tendineae in 37, mitral valve prolapse in 18, infective endocarditis in 20, coronary artery disease in 8, congenital heart disease in 5, and dilated cardiomyopathy in 4. No patient was found to have left atrial thrombus. Left atrial SEC was observed in three patients (1.7 percent), all of whom had atrial fibrillation, concomitant mitral stenosis, and huge left atria. Color flow mapping revealed that left atrial SEC was prominent in regions where the turbulent flow of MR was not present. Systemic embolism occurred in ten patients (5.7 percent). The underlying disease was infective endocarditis, rheumatic heart disease, and dilated cardiomyopathy in 6, 3, and 1 patient, respectively. The sites of embolization involved the central nervous system in eight patients and the spleen in the remaining two. Three patients with rheumatic heart disease and the one with dilated cardiomyopathy were in atrial fibrillation and had dilated left atria (diameter > 45 mm) when systemic embolism occurred. Only one patient with rheumatic heart disease was found to have left atrial SEC. The remaining six, with infective endocarditis, all had sinus rhythm. In conclusion, left atrial SEC or thrombus detected by TEE is uncommon in patients with significant MR. Clinical conditions may be of help to identify the subsets of patients at higher risk for systemic embolism.
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PMID:Significant mitral regurgitation is protective against left atrial spontaneous echo contrast formation, but not against systemic embolism. 802 Mar 25


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