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

Nineteen patients with infective endocarditis underwent surgery. Congenital heart disease was found in 6 patients, valve disease in 13. Seven patients had history of rheumatism. Congestive heart failure was noted in 17 patients, arterial embolism in 3, and pulmonary infarction in 1. Blood culture was positive in 36.8%, while vegetations were detected echocardiographically in 58.8% of the patients. Selective surgery was performed in 17 patients and emergency operation in the rest two. There was no operative death. Follow-up for 3-109 months after operation showed no evidence of recurrent endocarditis. We suggest that early surgical treatment is mandatory for intractable infective endocarditis if excellent result is expected.
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PMID:[Surgical treatment of infective endocarditis]. 181 20

Pneumococcal endocarditis has declined sharply in incidence since the advent of penicillin but remains a potentially lethal infection. From 1980 to 1984, pneumococcal endocarditis was diagnosed in seven patients--four adults and three infants. Apart from one patient who had had a splenectomy, there were no recognizable predisposing factors to infection due to Streptococcus pneumoniae, although all three children were younger than 15 months of age. Congenital heart disease was present in two patients, calcific aortic disease in one, and mitral valve prolapse in a fourth. The remaining three patients had previously normal hearts. Meningitis occurred in five (71%) of the seven patients. Five patients were cured of their infection: four by medical therapy alone (penicillin or vancomycin), and a fifth, by medical therapy plus valvular debridement. Two patients died: one with intractable heart failure, and the second, from the complications of cardiac surgery. Penicillin alone is effective therapy for pneumococcal endocarditis. Patients unable to tolerate penicillin may be treated with vancomycin.
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PMID:Pneumococcal endocarditis: report of a series and review of the literature. 353 18

Congestive heart failure in children is unusual as a presenting problem, and the nonspecific nature of the signs and symptoms in the pediatric population makes recognition difficult. Congenital heart disease is most common in the infant whereas older children most commonly develop congestive heart failure due to cardiomyopathy, myocarditis, electrolyte abnormalities, dysrhythmias, and, more rarely, endocarditis, and rheumatic carditis. Management focuses upon stabilization of the airway and ventilation while improving circulatory function. This is achieved by the use of inotropic agents, combined with attention to the volume and pressure overload, pulmonary problems, dysrhythmias, and ongoing follow-up.
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PMID:Congestive heart failure in children. 380 94

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

The authors undertook a retrospective study of 69 cases of infective endocarditis (IE) in 68 children treated from 1971 to 1992. The comparison between two groups (Group I comprising 34 patients treated between 1971 and 1981; Group II comprising 34 patients treated between 1982 and 1992) based on a review of the literature showed that the natural history of paediatric IE has changed during these two decades: a slight increase in the incidence in young children. The sequellae of rheumatic heart disease play no role in determining IE in France. Congenital heart disease plays a major role (72% of cases) with increasing numbers having undergone surgical treatment for more complex lesions. Mitral valve prolapse has become a more common cause with multiple portals of entry, predominantly buccal and oto-rhino-laryngeal. Blood cultures are positive in 75% of cases, the commonest organisms being Streptococci and Staphylococci, but the frequency of uncommon pathogens is increasing. Echocardiography plays a major role in the diagnosis and inventory of IE (vegetations demonstrated in 64% of cases in Group II). Although mortality is progressively decreasing (3% in Group II) because of more frequent surgical indications (32% in Group II) and more severe sequellae: only 27% of children in Group II were cured without sequellae or aggravation of their previous cardiac lesion.
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PMID:[Bacterial endocarditis in children]. 802 90

Twenty children were treated for infective endocarditis (IE) at Our Lady's Hospital for Sick Children during an eleven year period from January 1980 to December 1990. One child had I.E. on two occasions due to different microorganisms. Two had Down syndrome. Congenital heart disease (CHD) was the single most common underlying condition and there was none with rheumatic heart disease. Two had no clinically recognised cardiac anomaly. 13/20 (65%) had acyanotic heart disease and 5/20 (25%) had cyanotic CHD. Among the acyanotic group, ventricular septal defect was most common (6/13); followed by aortic lesions (4/13). There was one case each of coarctation of aorta, patent ductus arteriosus and interrupted aortic arch. Transposition of the great arteries was most common among the cyanotic group (3/5). Four children in the cyanotic group had systemic to pulmonary artery shunts; Blalock Taussig (2), Waterston (1), and aortopulmonary (1). Infection was caused by Streptococcus viridans in 10/20 (50%) and Staphylococcus aureus in 7/20 (35%). Kingella Kingae, Neisseria meningitidis and Streptococcus faecalis were the pathogens in the remainder (15%). Vegetations were detected by echocardiography in 12/19 (63%). The mean duration of antibiotic treatment was 5 weeks (1 day-18 weeks). Surgical intervention was necessary in 4 children (20%). Fifteen children (75%) survived and the mean follow up period was 22.6 months (15 days-6 1/2 years). The overall mortality was 25%.
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PMID:Eleven year review of infective endocarditis. 805 46

Due to changing characteristics of infective endocarditis in the past two decades, we, retrospectively analysed 28 cases of infective endocarditis in children of age less than 15 years at Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar from December, 1983 to November, 1993. The incidence of disease was observed as 1.5 cases/1000 children admitted with a M:F ratio of 2:1. Three patients were of age less than 2 years (group I) as 25 were above 2 years of age (group II). The two groups had significant difference in portal of entry of infection, infective microorganisms, echocardiography and prognosis. Congenital heart disease was the commonest underlying cardiac lesion in 24 (85.71%) patients. Portal of entry of infection was apparent in 35.71% only; dental route being more frequent in group II. Streptococcus viridans (in 9 cases) followed by staphylococcus aureus (in 4 cases) were the two common organisms isolated. Patients were treated, for a period of 4-6 weeks with a over all mortality rate of 25%. Factors associated with poor prognosis were age < 2 years, staphylococcal infection ad negative blood cultures. Heart failure resistant to medical therapy was a leading cause of death.
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PMID:Infective endocarditis in infants and children. 1082 90

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.
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PMID:Early surgical intervention for infective endocarditis. 1253 71

We report a case of pediatric pneumococcal endocarditis (PPE) and review the English language literature on this disease. Thirty-two cases of PPE were identified since 1900. One-fourth of these were reported since 1990. Clinical features differed from adult cases, with mitral valve involvement being more frequent and Osler's triad rarely present in children. Congenital heart disease was the only identifiable risk factor. Medical therapy alone resulted in a high mortality rate that was improved in the group of patients receiving combined medical and surgical interventions. PPE is a rare infection that has been reported more frequently in the era of increasing antibiotic resistance. Unlike typical "subacute" endocarditis caused by viridans streptococci, PPE is an aggressive disease with a high mortality rate. Early surgical intervention might improve survival.
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PMID:Pneumococcal endocarditis in infants and children. 1487 86

Ever since the last American Heart Association (AHA) publication on prevention of infective endocarditis (IE) many medical societies and physicians have questioned the efficacy of prophylaxis in patients that undergo a dental, genitourinary (GU) or gastrointestinal (GI) procedures. In 1997 AHA recognize that most cases of IE were not related to invasive procedures but as a result of arbitrarily occurring bacteremia from routine daily activities as well as recognition of the possibility of IE prophylaxis failure. This assumptions as well as review of numerous published studies over the past two decades caused that AHA to revise the guidelines of 1997. Based on published series this new guidelines identify the following underlying cardiac conditions with an increase risk of IE and are the ones in which prophylaxis is recommended. They include (1) prosthetic cardiac valve or prosthetic material used for cardiac valve repair, (2) previous IE, (3) Congenital Heart Disease (CHD) including unrepaired cyanotic as well as palliative shunts and conduits, completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure, repaired CHD with residual defects and (4) cardiac transplantation recipients who develop cardiac valvulopathy. All dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa will require IE prophylaxis. Patients that undergo respiratory tract procedure that involves incision or biopsy of the respiratory mucosa will also required IE prophylaxis. In contrast to previous AHA guidelines, antibiotic prophylaxis to prevent IE is not recommended for GU or GI procedures. First line therapy recommended includes amoxicillin or ampicillin and if allergic to penicillin, clindamycin 600 mg or azithromycin 500 mg. Antibiotics should be administered in a single dose before the procedure, but the dosage may be administered up to two hours after procedure. This new AHA recommendation are more clear for healthcare providers regarding to which patient should undergo prophylaxis in comparison with previous ones and are expected to reduce antibiotic resistance that increased during the past years as a result of previous antibiotic prophylaxis for IE.
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PMID:Prevention of infective endocarditis: a review of the American Heart Association guidelines. 1940 May 26


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