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

Twenty specimens of heart with mycotic aneurysms at the aortic root were studied. In ten cases, mycotic aneurysm followed infection of the aortic valve. In one case, it developed following infection of an aortic jet lesion, and in nine patients, the aneurysm was at the seat of a prosthetic aortic valve. In seven of the 11 cases with a natural aortic valve, the valve was either unicuspid or bicuspid. A retrospective evaluation of the data on the clinical records of the 20 patients revealed that infective endocarditis or noncardiac postoperative sepsis was present in 11. The most frequently isolated microorganism was Staphylococcus aureus. Conduction disturbances were found in six patients, all of them with involvement of the atrioventricular node by the aneurysm. Perforation into intracardiac cavities was found in four, two into the right ventricular infundibulum and one each into each atrium. Pericardial tamponade was caused by bleeding from the aneurysm in two cases, and myocardial infarction was a probable consequence of coronary arterial compression by the aneurysm in two cases. Mycotic aneurysms of the aortic root, in spite of their being partially or completely healed of active infection, carry a high risk of the complications enumerated. Among the 20 cases, cultures were positive in 11 and negative in nine. Staphylococcus aureus was cultured from five of the cases.
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PMID:Mycotic aneurysms of the aortic root. A pathologic study of 20 cases. 375 65

Neurologic complications continue to occur in approximately 30 per cent of all patients with infective endocarditis and represent a major factor associated with an increased mortality rate in that disease. Of these complications, cerebral embolism is the most common and the most important, occurring in as many as 30 per cent of all patients, most of whom ultimately die. Emboli that are infected also account for all the other complications (mycotic aneurysm, meningitis or meningoencephalitis, brain abscess) that may develop. Emboli are more common in patients with mitral valve infection and in those infected with more virulent organisms. Mycotic aneurysms (often preceded by an embolic event) occur more frequently and earlier in the course of acute endocarditis, rather than later, which is more common in the course of subacute disease. The management of a cerebral mycotic aneurysm depends on the presence or absence of hemorrhage, its anatomic location and the clinical course. Healing can occur during the course of effective antimicrobial therapy and thus will preclude the need for automatic surgery in all angiographically demonstrated aneurysms. The indication for surgical intervention must be evaluated on an individual basis. Meningitis is usually purulent when associated with virulent organisms, but the CSF may present an aseptic formula when associated with subarachnoid hemorrhage or multiple microscopic embolic lesions, infected or otherwise. Macroscopic brain abscesses are rare, but multiple microscopic abscesses are not uncommon in patients with acute endocarditis due to virulent organisms. Seizures are not uncommon in patients with infective endocarditis. Focal seizures are more commonly associated with acute emboli, whereas generalized seizures are more commonly associated with systemic metabolic factors. Penicillin neurotoxicity should be considered in seizure patients with compromised renal function who are receiving high doses of penicillin. The CSF tends to reflect the nature of the infecting organism rather than the nature of the neurologic complication, except when hemorrhage is present. Endocarditis due to virulent organisms, such as Staphylococcus aureus, is usually associated with a purulent CSF formula, whereas non-virulent organisms, such as "viridans" streptococci, usually have aseptic or normal CSF formulas.
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PMID:Neurologic complications of infective endocarditis. 383 85

Two cases of pulmonary artery aneurysm are reported in patients with persistent ductus arteriosus (PDA). The first was a mycotic aneurysm complicating staphylococcal pneumonia; the other was a calcific aneurysm of the right pulmonary artery. The mycotic origin was confirmed in the first case. The aetiological roles of pulmonary hypertension and previous endocarditis are discussed in the second case. Based on these two observations, the authors analyse the aetiology and evolution of mycotic aneurysms and review the therapeutic problems posed by their association with PDA.
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PMID:[Pulmonary artery aneurysms in patent ductus arteriosus]. 393 46

Seventy-five patients received 80 Medtronic-Hall valve prostheses during a 24-month period at the Beilinson Medical Center. The mean age was 50 years and the majority of patients had rheumatic heart disease. All operations were elective. There were 4 early and 2 late deaths (8%). Four patients needed re-operation for paravalvular leaks, 3 of them survived the second operation and one patient with prosthetic valve endocarditis did not. One patient was re-operated on successfully because of a mycotic aneurysm in the ascending aorta. Mild subclinical hemolysis (elevated SLDH and reduced haptoglobin) was found in the majority of patients. Hemolysis was found to be significantly lower in type D 16 prostheses patients. Mild hemorrhagic complications occurred in 2 patients due to anticoagulant therapy. Three patients suffered from prosthetic valve endocarditis (PVE), 2 of them responded to prompt medical therapy. There were no thromboembolic episodes. Most surviving patients experienced marked postoperative improvement. Within the 24-month follow-up period, the Medtronic-Hall valve compared favorably with other disk or ball prostheses previously and currently used in our department.
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PMID:Two years experience with Medtronic-Hall prostheses in 75 patients with special reference to its thrombogenicity and hemolysis. 619 39

Ruptured aneurysms of the sinus Valsalvae are relatively rare. Six patients have undergone operative treatment in our hospital in a 13-year period. Five of these, all men between the ages of 33 and 54 had a ruptured congenital aneurysm. Acquired aneurysms may occur and rupture at any age. One patient in our series had a mycotic aneurysm. Endocarditis was quite frequently encountered and seemed to play a role at the onset of rupture. Surgical technique consisted of direct closure in 4 patients and closure with a Dacron patch in 2 patients. Repair was successful in 5 patients. The patient with the mycotic aneurysm died after repeated surgery because of septic complications. Mean follow-up now is 3 1/2 years. Ruptured aneurysms of the sinus Valsalvae should be treated operatively by a double approach and, in the presence of an acute progressive endocarditis, without delay.
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PMID:Ruptured aneurysms of the sinus Valsalvae. 620 93

Endocarditis and mycotic aneurysm of the great blood vessels are two serious complications of non-typhoidal salmonella gastroenteritis. Two patients are presented, the first with endocarditis due to S. dublin cured by combined treatment with ampicillin and gentamicin, the second with a fatal aneurysm of the aorta caused by Salmonella infantis. Salmonella endocarditis, particularly with left-sided cardiac involvement, has an especially poor prognosis. Survival is rare without surgery. Chemotherapy should consist of a synergistic combination such as ampicillin with an aminoglycoside for a period of 4-6 weeks. Mycotic aneurysm generally results from haematogenous infection of a previously damaged arteriosclerotic vessel. Salmonella spp. cause approximately 20% of all mycotic aneurysms and there is some evidence to suggest that their role is increasing. Repeatedly positive blood cultures in spite of antimicrobial treatment in an elderly patient should raise the suspicion of an endovascular localisation of the infection. Rapid surgical intervention and appropriate chemotherapy are needed before rupture takes place.
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PMID:Salmonella infections of the mitral valve and abdominal aorta. 654 64

Since the advent of modern antibiotic therapy and active surgical treatment of bacterial endocarditis, septic embolization of the systemic circulation is rarely seen. An unusual presentation of a mycotic aneurysm with gastrointestinal haemorrhage in a patient with non-Hodgkin's lymphoma and aortic valvular endocarditis which had been managed by aortic valve replacement six weeks before the haemorrhage occurred is reported.
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PMID:Mycotic aneurysm of the small bowel presenting as gastrointestinal haemorrhage. 661 Aug 17

We are presenting a case of endocarditis due to a penicillin-tolerant Streptococcus bovis in a 65-year-old patient. The minimal bactericidal concentration of penicillin (40 mg/l) was more than 100-fold the minimal inhibitory concentration (0.08 mg/l). The MBC of penicillin was 0.31 mg/l in the presence of 1.25 mg/l gentamicin. Cross-sectional echocardiography revealed endocarditis of the anterior leaflet of the tricuspid valve and a vegetation on the aortic valve which appeared to be pedunculated and which prolapsed into the left ventricular outflow tract during diastole. During therapy, the pedunculated part of the vegetation disappeared without signs of embolization. After initial clinical improvement, the patient died of cerebral bleeding caused by a mycotic aneurysm of the left median cerebral artery. The patient's final outcome suggested an asymptomatic embolus. Cross-sectional echocardiography was distinctly superior to M-mode echocardiography in estimating changes in the size and shape of the valve vegetation. The results of the post-mortem examination of the aortic and tricuspid valves corresponded to the echocardiographic findings.
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PMID:Endocarditis due to a penicillin-tolerant streptococcus bovis: microbiological findings and echocardiographic follow-up. 666 68

The surgical management of eight patients with infective endocarditis and intracerebral mycotic aneurysm is presented. Three patients had craniotomy before valve replacement and four patients had valve replacement before craniotomy. There were no deaths related to the valve replacement or craniotomy. Two of the eight patients died in the hospital of continuing sepsis resulting from undrained foci of infection. It is concluded that the drug-addicted patient with a mycotic aneurysm and hemodynamic decompensation from endocarditis can be successfully treated by staging the operations according to the more severe problem.
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PMID:Operative experience with infective endocarditis and intracerebral mycotic aneurysm. 689 38

Three cases of mycotic aneurysm of the renal artery are presented, all of which manifested similar findings on excretory urography and renal arteriography: small intrarenal aneurysm with distal occlusion, corresponding nephrographic defect or defects on urography and arteriography, and opacification of a normal collecting system. To the authors' knowledge these findings have not been reported previously, and they appear to represent a distinctive combination of findings diagnostic of mycotic aneurysm. The significance of recognizing this pattern, particularly as an aid in establishing an early diagnosis of infective endocarditis, is stressed.
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PMID:Mycotic aneurysm of the renal artery. 689 33


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