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 15,629 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pitfalls in the clinical diagnosis of the aetiology of acquired tricuspid incompetence in children were exemplified in five patients. In three of them acute staphylococcal endocarditis, the cause of the valve defect, was obscured during life by co-existing sickle cell haemoglobinopathy, acute leukaemia and rheumatic mitral valvulitis, respectively. The fourth and fifth patients had clinical features suggestive of right ventricular endomyocardial fibrosis but necropsy revealed that the tricuspid incompetence was caused by dilated cardiomyopathy and constrictive pericarditis respectively. This series illustrates the need to suspect bacterial endocarditis if a child presents with signs of infection and valvular incompetence, and also dispels the widespread belief that pericardial constriction does not cause tricuspid incompetence.
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PMID:Acquired tricuspid incompetence in children: pitfalls in the clinical diagnosis of its aetiology. 619 11

The authors report the long-term results of 309 patients undergoing isolated mitral valve replacement with a 6120 Starr Edwards mitral valve prosthesis in the great majority of cases, mainly for rheumatic mitral valve disease, with predominant mitral regurgitation. The average age was 26 +/- 14 years with 25% of children. The operative mortality was 9% and late mortality after a mean follow-up period of 4 years was 13,5% mainly due to thromboembolic complications and to myocardial dysfunction. The long-term results with an average 45 month follow-up showed a 10 year survival rate of 70,6% with an excellent clinical result in 71% of cases and an acceptable result in 10%; 20% of patients were considered poor long-term results because of myocardial dysfunction and thromboembolic complications. Endocarditis and perivalvular leaks were rarely observed (9 cases). A study of preoperative parameters which could influence long-term results showed that the quality of long-term survival was significantly correlated to age, the duration of cardiac disease before surgery, cardiomegaly and the presence of preoperative cardiac failure and tricuspid regurgitation. The incidence of thromboembolism was 4,7% patient years and the frequency of these complications was not related to the quality of anti-vitamin-K therapy. Patients under effective anticoagulant therapy had the highest incidence of haemorrhage (10%). This study confirms that the Starr Edwards 6120 prosthesis is a satisfactory choice for mitral valve replacement considering its durability (no cases of abnormal wear) and the 70% ten year survival rate. The problem of myocardial dysfunction could be resolved by earlier surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fate of Starr-Edwards prostheses in the mitral position. Prognostic factors. Apropos of 309 cases]. 643 71

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

To determine long-term postoperative results in patients with double-chamber right ventricle and ventricular septal defect, 20 patients who had survived complete repair between 1959 and 1966 were recalled and studied. An interview, physical examination, electrocardiogram and chest x-ray were performed in all 20 patients, a treadmill exercise test in 16, 24-hour Holter monitor recording in 7 and postoperative cardiac catheterization in 8. Mean age at repair was 14 years and at follow-up evaluation 33 years. There were no late deaths. At a mean follow-up of 19 years, 17 patients were in New York Heart Association functional class I, 1 patient was in class II and 2 patients were in class III. Reoperation was performed in 2 patients (10%), and at present only 1 patient (5%) is considered to have hemodynamically significant cardiac compromise. Aortic regurgitation, not present in any patient preoperatively, developed in 5 patients (25%). Mild residual right ventricular outflow obstruction was present in 2 (10%) and the murmur of a hemodynamically insignificant residual ventricular septal defect or tricuspid regurgitation was present in 5 patients (25%). One patient (5%) had cardiomegaly (cardiothoracic ratio greater than 0.55). The frequency of infective endocarditis in the postoperative follow-up period was 1 per 388 patient-years. Thus, 20 years after repair of double-chamber right ventricle, mild residua and sequelae are common, but serious cardiac compromise is infrequent.
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PMID:Long-term prognosis after repair of double-chamber right ventricle with ventricular septal defect. 650

A case of congenital tricuspid incompetence in a 39 year old woman is reported. The patient, who was in suffering congestive heart failure, had no history of trauma, myocardial infarction, rheumatic fever, infective endocarditis. Right ventriculography and right atrial pressure recording both showed signs of severe tricuspid insufficiency. Echocardiography showed dilatation of the right ventricle and atrium, and the lack of normal systolic coaptation of anterior and septal tricuspid leaflets, while contrast echocardiography gave direct evidence of regurgitation. Valvular replacement with a bioprosthesis was carried out. The diagnosis of congenital tricuspid incompetence was confirmed at operation. The patient is asymptomatic at one year follow up.
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PMID:[Congenital tricuspid insufficiency due to valvular dysplasia]. 651 Jun 24

This is the case report of 3 surgical patients with infective endocarditis in childhood. Case 1: A 8 year-old boy was admitted with high fever and congestive heart failure. Aureus staphylococci were identified by blood culture. Echocardiogram showed a vegetating mass on the posterior mitral leaflet. This patient was cured by emergency mitral valve replacement during the active phase of infection. Case 2: A 3 year-old girl was admitted with infective endocarditis related to VSD. Viridans streptococci were identified by blood culture. Echocardiogram showed a vegetating mass on the septal tricuspid leaflet. After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty. Case 3: A 7 year-old boy was admitted with infective endocarditis related to VSD. Aureus staphylococci were identified with blood culture. Echocardiogram showed a vegetating mass on the anterior tricuspid leaflet and moderate tricuspid regurgitation. After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty. We believe that echocardiography plays an important role in the diagnosis and management of infective endocarditis and that tricuspid valvuloplasty is the method of first choice in treatment of the patient with regional tricuspid infective endocarditis.
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PMID:[Surgical treatment of infective endocarditis in childhood--report of 3 cases]. 674 14

A previously healthy 8-year-old girl with a normal heart had development of tricuspid valve staphylococcal endocarditis. Serial two-dimensional echocardiograms first demonstrated an enlarging vegetation and later showed reduction in its size coincident with a pulmonary embolus. The occurrence of the pulmonary embolus along with persistent fevers, despite adequate antibiotic treatment, prompted surgical intervention. Surgical excision of a large residual vegetation, valve debridement, and pulmonary embolectomy led to prompt subsidence of fever and improvement in the patient's condition. Three months after surgery, the child remained asymptomatic with minimal tricuspid insufficiency. However, by eight months after surgery, the hemodynamic consequences of the tricuspid insufficiency had progressed, and the patient is mildly symptomatic. Additional tricuspid valve repair or replacement is expected.
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PMID:Echocardiographic diagnosis of tricuspid valve endocarditis in a child with a normal heart. Special emphasis on surgical considerations. 708 24

A newborn baby is admitted in the second week of life with osteomyelitis and septicemia due to Staph. aureus infection. In his tenth week of life--the osteomyelitis nearly overcome--the infant shows signs of heart failure with a murmur and cyanosis. Cardiac catheterization reveals tricuspid insufficiency and thrombosis of the right pulmonary artery. Postmortem examination shows isolated polypous endocarditis of the tricuspid valve together with thrombosis of the right and recent embolus of the left pulmonary artery. A similar case has to the best of our knowledge not been described.
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PMID:[Isolated endocarditis of the tricuspid valve in early infancy]. 720 2

A case is reported in which acute tricuspid regurgitation developed in a child with a ventricular septal defect resulting in a left ventricular-right atrial shunt. This was successfully treated by closure of the defect and tricuspid valve replacement. The anterior leaflet of the tricuspid valve was almost completely destroyed by endocarditis, though in previous reports of tricuspid valve endocarditis in association with ventricular septal defect in children, it has beem invariably the septal leaflet which is damaged.
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PMID:Severe heart failure in child with ventricular septal defect and acute tricuspid regurgitation. 742 50

Endocarditis of transvenous pacing leads is a rare condition. The authors review a series of 15 patients who developed bacteriologically proven septicaemia and/or endocarditis related to transvenous pacing leads, operated between 1988 and 1993. The interval between the last manipulation of the pacemaker and the onset of endocarditis was about 6 months. Six patients had had haematoma and/or infection of the pacemaker site. Endocarditis presented with chronic pyrexia (14 cases) associated with septicaemia (6 cases) and chronic local suppuration (1 case). The interval between the beginning of the pyrexia and the diagnosis was 3.4 months. Echocardiography showed a mass attached to the pacing lead in 8 cases and tricuspid valve vegetations in 4 cases. Blood cultures were positive in 13 patients and local wound swabs identified the organism in 1 patient. The commonest causal agent was the staphylococcus (epidermis in 7 cases, aureus in 4 cases). Appropriate antibiotic therapy was only effective in 1 case. The surgical indication in 13 cases was persistence of infection associated with pulmonary embolism (3) or tricuspid regurgitation (2). Complete ablation of the prosthetic material was performed by a peripheral vascular approach (2 cases), by a right atrial approach (1 case) and under cardiopulmonary bypass in 12 cases. The peroperative findings were of tricuspid valve vegetations (4 cases), thrombi on the pacing lead (7 cases) or in the right heart chambers (2 cases) or pulmonary artery (2 cases). The associated procedures performed under cardiopulmonary bypass were tricuspid valve repair (2 cases) and pulmonary thrombectomy (2 cases). Temporary and permanent epicardial leads were implanted in 10 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Septicemia and endocarditis related to transvenous pacing leads of pacemakers: surgical indications and results]. 748 73


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