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

Haemophilus parainfluenzae endocarditis is characterized by great variation in the acuteness of presentation, difficulty in isolation of the pathogen, a 50% to 60% incidence of major arterial emboli, and variability of response to therapy. Prosthetic valve endocarditis (PVE) due to H parainfluenzae biotype II occurred in a 14-year-old girl with congenital heart disease and a Starr-Edwards mitral valve prosthesis. Management was complicated by a prolonged culture-negative period (eight days), intermittent bacteremia (only five of 15 positive blood cultures), an embolus to the right femoral artery, progressive congestive heart failure, and urgent prosthestic valve replacement. Cure was achieved with 44 days of ampicillin sodium-gentamicin sulfate therapy monitored by serum bactericidal titers.
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PMID:Prosthetic valve endocarditis due to Haemophilus parainfluenzae biotype II. 44 17

A women who developed mitral stenosis from Libman-Sacks endocarditis is described. The mitral valve was replaced by a Starr-Edwards prosthesis. One year later, despite her being maintained on steroids and azathioprine, the verrucous endocarditis progressed to cause sudden, severe dysfunction of the prosthetic valve.
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PMID:Mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis. 46 48

Bacterial endocarditis caused by Actinobacillus actinomycetemcomitans is a rare disease. A 48-year-old man who had a Starr-Edwards aortic valve prosthesis inserted in 1972 was admitted for evaluation of confusion, headaches, anorexia, weight loss, diarrhea and weakness. Six blood cultures yielded gram-negative organisms which were subsequently identified as A. actinomycetemcomitans. Treatment with ampicillin and gentamicin resulted in cure which has been maintained after an observation period of eleven months. This represents the second report of A. actinomycetemcomitans endocarditis in a patient with a prosthetic valve.
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PMID:Actinobacillus actinomycetemcomitans endocarditis in a patient with a prosthetic aortic valve. 88 Dec 58

The two principal considerations with prosthetic valves are durability and thromboembolism. With the widespread interest in recently developed prosthetic valves (porcine, tilting disc, Cooley), the long-term results at one institution with a single prosthesis were considered of particular importance. Accordingly, a 97% follow-up has been completed on 1375 patients (pts) undergoing prosthetic valve replacement with the Starr-Edwards cloth-covered steel ball prosthesis at New York University between October 1967 and December 1975. Operative procedures were as follows: aortic valve replacement (AVR): 470 pts; mitral valve replacement (MVR): 362 pts; combined AVR and MVR: 129 pts; other combined procedures: 414 pts. Overall operative deaths were 13.7%, 9% for AVR, 10.8% for MVR, and 18.6% for combined AVR and MVR. At seven years, AVR survival was 64%, and MVR survival 64.5%. There has been widespread pessimism, usually without significant data, about the cloth-covered prosthesis, because of concern of cloth wear, hemolysis and other complications. Therefore, a particularly significant finding by actuarial analysis was that 85% of surviving patients with isolated AVR remained free of emboli for five years. In pts surviving isolated MVR, 80% remained free of emboli for five years. Of those having embolic episodes, 33% were not on anticoagulants. Fatal hemorrhage from anticoagulants occurred in 0.8% of pts. Endocarditis occurred in 5.7% of the entire group, with 1.3% requiring reoperation. Clinically significant hemolysis occurred in 5.1% of the group, with only 0.2% requiring reoperation. Hence, the total frequency of clinically significant cloth-wear was less than 0.5%. These data indicate both the reliability and the limitations of the Starr-Edwards cloth-covered steel ball valve and can be used in comparing experiences with the more recently developed prostheses.
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PMID:Long-term results in 1375 patients undergoing valve replacement with the Starr-Edwards cloth-covered steel ball prosthesis. 88 74

Starr-Edwards mitral and aortic prosthetic valves served as nidi for endocarditis due to M chelonei. Cultural, physiologic, lipid chromatographic, and serologic studies identified the organism as M chelonei (abscessus).
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PMID:Prosthetic valve endocarditis due to Mycobacterium chelonei. 96 52

The case is described of a 49-year-old woman who developed endocarditis in relation to the prosthetic valve two months after insertion of a Starr-Edwards mitral valve prosthesis. Initially Corynebacterium hofmanni was isolated from blood culture. Later, while the patient was receiving antibacterial chemotherapy, Candida albicans was also isolated and she was treated with 5-fluorocytosine. A cure was effected without the need for further valve replacement.
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PMID:A case of prosthetic valve endocarditis caused by Corynebacterium hofmanni and Candida albicans. 119 36

Potential morbidity remains substantial in aortic root replacement. The tissues are often fragile, contributing to the risk of haemorrhage and postoperative complications. In the past surgery has been directed towards minimising haemorrhage by wraparound techniques and the right atrial fistula method of Cabrol. However, recent use of aortic homografts, collagen-impregnated grafts and tissue glues have reduced bleeding and simplified operative technique. Profound hypothermia and total circulatory arrest allows aneurysm resection to extend into the aortic arch. Between 1986 and 1991 25 aortic root replacements were carried out at the Oxford Heart Centre in 21- to 76-year-olds, 13 for aorto-annular ectasia (4 due to Marfan's syndrome), 7 for aortic dissection (2 Marfan's syndrome) and 2 for complications of previous aortic valve replacement. Three patients had homograft root replacement for aortic root endocarditis. We implanted 14 Medtronic composite grafts, 1 St Jude conduit and 7 collagen-coated Dacron grafts (Hemashield, Meadox) into which a Starr-Edwards valve was sewn, as well as 3 homografts. One patient with a massive chronic dissection following previous aortic valve replacement required an interposition graft to the coronary ostia. In the others, the coronary ostia were mobilised from the native aorta and directly implanted into the conduit. In dissections a ring of pericardium or GoreTex was used to buttress the coronary anastomoses. Six patients also required coronary artery grafting. Native aorta was excised and not wrapped around the conduit. Coagulation defects were corrected aggressively with platelets, fresh frozen plasma and cryoprecipitate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aortic root replacement: modifications of technique with improvements in technology. 138 78

We followed 155 children aged 6 to 16 years who underwent mitral valve replacement for rheumatic heart disease. Group I included 74 patients with Starr-Edwards prostheses and the mean follow-up period was 13 years. Group II was formed by 36 patients with Bjork-Shiley prostheses and a mean follow-up of 7.5 years. Group III consisted of 31 children with dura mater bioprostheses and a mean follow-up of 5.1 years. Finally, group IV included 14 patients followed a mean period of 4.9 years with Hancock xenografts. The four groups of patients were comparable before surgery. The criteria of the New York Heart Association (NYHA) were used to evaluate all patients before and 12 months after surgery. All patients with mechanical prostheses received anticoagulant therapy with acenocumarol from the first postoperative day. The incidence of complications such as thromboembolism, infective endocarditis, prosthetic dysfunction and death were determined at the end of the follow-up. The Fisher's exact test was used for nonparametric analysis and the two-tailed Student's T test for parametric results. All but two patients improved their NYHA clinical status after surgery (p less than 0.0001). Forty eight patients with mechanical prostheses were catheterized 1 to 7 years after the operation. The mean pulmonary arterial systolic pressure was reduced from 58 mmHg to 30 mmHg (p less than 0.001) and the mean pulmonary arterial wedge pressure decreased from 22 mmHg to 11 mmHg (p less than 0.001). There were no significant differences between the groups with mechanical and tissue prostheses in the incidence of thromboembolism and infective endocarditis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Late results of mitral valve replacement in 155 subjects under 16 years of age. Comparative study with 4 prosthesis]. 141 51

The Duromedics (Baxter Healthcare Corp., Edwards CVS Div., Irvine, Calif.) mechanical cardiac valvular prosthesis was implanted in 480 patients between 1984 and 1987 at the Montreal Heart Institute, the Hospital Clinic of Barcelona and the teaching hospitals of the University of British Columbia. The mean age of the patients was 52 years. The early mortality was 7.9% and the late mortality was 4.1% per patient-year. The overall survival at 4 years for aortic valve replacement (AVR) was 87.0% +/- 3.7% and for mitral valve replacement (MVR) was 81.9% +/- 2.9%. There were 16 valve-related reoperations in 14 patients--for prosthetic valve endocarditis in 9 patients, for thromboembolism in 1 patient and for nonstructural dysfunction in 4 patients. The freedom from thromboembolism at 3 and 4 years was 94.3% +/- 3.1% for AVR and 95.1% +/- 1.8% for MVR. The freedom from prosthetic valve endocarditis at 3 and 4 years was 95.3% +/- 2.2% for AVR and 96.2% +/- 1.6% for MVR. The freedom from structural valve deterioration for all positions was 100%. The freedom from reoperation at 4 years was 95.3% +/- 2.1% for AVR and 92.3% +/- 4.3% for MVR and from valve-related death was 98.7% +/- 1.3% for AVR and 96.2% +/- 1.6% for MVR. The freedom from all valve-related complications at 4 years was 87.7% +/- 3.8% for AVR and 85.7% +/- 2.9% for MVR. Long-term evaluation of the Duromedics prosthesis is required to determine the influence of documented structural valve deterioration.
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PMID:Clinical performance of the Duromedics bileaflet pyrolite mechanical prosthesis. 145 86

Thirty-four young patients (28 male and 6 female) underwent aortic valve replacement between 1972 and 1988. Ages ranged from 11 to 20 years (mean 17.7 years). Including reimplantation in the follow-up period, 40 valves were implanted, among which were 17 (43%) St. Jude, 7 (16%) Bjork-Shiley, and 4 (10%) Carpentier-Edwards. Seven patients (18%) had tissue valve prostheses (4 Carpentier-Edwards, 3 Hancock valves). There was one hospital death (2.9%). Follow-up was obtained in 30 of the 33 hospital survivors, with a mean follow-up of 80 months. In the follow-up period, one patient (3%) had a major thromboembolic event and one patient (3%) had prosthetic valve endocarditis. Six patients (18%) required replacement of the implanted valve; three of these had received Hancock tissue valve prostheses. There were three late deaths, yielding 96% survival at 5 years and 84% at 10 years. Twenty-three of 30 survivors are currently New York Heart Association class I. Aortic valve replacement in young patients can be performed with low mortality and morbidity, and with excellent long-term results.
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PMID:Aortic valve replacement in young patients: long-term follow-up. 146 30


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