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

The authors have studied the short and long term results of surgical treatment of acute phase of infectious endocarditis in a group of 33 high risk patients with valvular heart disease. The age varied from 2 to 68 years; 18 patients were male and 22 were of the white race. The aortic valve was most frequently involved (18/54.5%), followed by the mitral valve (13/39.3%) and tricuspid valve (2/6.0%). Twenty four patients (72.7%) were in functional class III and seven (21%) in functional class IV. The noninvasive studies in those patients revealed 13 cases (39.4%) with normal cardiac size. The ECG was abnormal in 27 cases (81.8%) mostly with left atrial and ventricular hypertrophy. The echocardiogram revealed the presence of vegetations in 27 patients (81.8%) and blood cultures were positive in 22 cases (66.6%). All patients were treated with antibiotics. The pathologic analysis revealed the presence of vegetations in 94% and structural alterations in 16.5%. Twenty-one patients had heart valve replacement with mechanical prosthesis (63.6%), 11(33.3%) had bioprosthesis and one had tricuspid excision without replacement (3.0%). The hospital mortality was 12% and the late mortality 3%. Three deaths occurred in patients who had prolonged clinical treatment (more than 65 days) and one patient died of severe fungal endocarditis. The follow-up of the remaining 26 patients varied from 01 to 448 weeks (mean 183) demonstrating important clinical improvement and a normally functioning valve prostheses. All patients are in functional class I and II. The analysis of our data indicates that surgical treatments is the best option for high risk endocarditis and should be undertaken earlier in all patients in this risk group.
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PMID:[Surgical treatment of high-risk valvular endocarditis]. 263 58

The cardiomyopathies are defined and classified into hypertrophic, dilated and restrictive types. In hypertrophic cardiomyopathy the major abnormalities of structure (massive ventricular hypertrophy, myofibrillar disarray, and narrow intramural coronary arteries) and of function (excessive ventricular contraction, systolic pressure gradients, increased ventricular stiffness with impaired relaxation and a tendency for sudden death) are used as the basis for selective and rational treatment with beta-blocking, calcium blocking, or antiarrhythmic agents, or a combination. Treatment is aimed at relieving symptoms, improving prognosis and slowing the progress of disease. Additional methods of treatment involving pacemakers and defibrillators are covered, and the place of septal resection, mitral valve replacement and cardiac transplantation discussed. General management and advice to the patient, and the treatment of complications such as atrial fibrillation, congestive heart failure and infective endocarditis, are also covered. In dilated cardiomyopathy measures to improve ventricular function by vasodilator therapy and the place of antiarrhythmic and anticoagulant drugs are discussed. The controversial treatment with beta-adrenergic blocking agents is reviewed, and the place of immunosuppressive therapy assessed. The possible use of antiviral agents in the future is commented upon, and cardiac transplantation is emphasised as the most effective, although radical, means of improving prognosis in intractable cases. In restrictive cardiomyopathy due to endomyocardial fibrosis, treatment of the initial inflammatory stage with steroids or sulphonylurea, and of the later fibrotic and thrombotic stage with anticoagulants and endocardectomy, is surveyed. The possible place of cardiac transplantation both for endomyocardial fibrosis and amyloid heart disease is mentioned, caution being urged when either of these conditions involves organs other than the heart.
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PMID:Clinical decisions in the management of the cardiomyopathies. 269 49

Necropsy findings were examined in 20 male patients with end-stage renal disease associated with longstanding spinal cord injury and treated with maintenance hemodialysis. All patients exhibited cardiovascular abnormalities. Fibrinous pericarditis was found in 50% of the patients. Left and right ventricular hypertrophy was present in 45% and 20% of the cases, respectively. The respective incidences of left and right ventricular dilatation were 40% and 30%. Cardiac amyloidosis was noted in 25% of the cases, whereas myocardial fibrosis was found in 45% of the patients. Valvular abnormalities were limited to one case of aortic stenosis and two cases of mitral ring dilatation. No evidence of infective endocarditis was observed despite the high incidence of infections in this population. Whereas 45% of the patients exhibited some degree of coronary arteriosclerosis, none exhibited evidence of acute myocardial infarction and only one showed pathologic changes consistent with old myocardial infarction. Aortic atherosclerosis was noted in the majority of patients.
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PMID:Cardiovascular pathology in dialysis patients with spinal cord injury. 622 12

There are a number of difficulties inherent in the analysis of such a large and diverse quantity of data. In a substantial number of clinical trials, there is no significant effort made to evaluate prosthetic performance as a function of preoperative cardiac anatomy. Hemodynamics have not been systematically studied in relation to preexisting left ventricular size, shape, or configuration, mitral annular orientation, or left atrial size. Postoperative anticoagulation protocols vary from one institution to another and occasionally within study groups themselves. Less tangible variables such as alteration in surgical technique over time and differential familiarity of cardiovascular surgeons with the prostheses employed are chronic problems in any study of this sort. Perhaps the greatest variable in evaluating the postoperative performance of valvular prostheses over the past 20 yr is the radical improvement in techniques of intraoperative myocardial preservation. Notwithstanding, comparisons are possible within the confines of certain criteria. The caged ball value remains in use after 20 years of clinical experience. It has sustained the greatest number of modifications, probably because it has been the most extensively studied. Hemodynamics are adequate although its centrally obstructed design is responsible for increased turbulence, hemolysis, and neointimal proliferation, particularly in the aortic position. The device has been shown to be durable with virtually no reports of ball variance since the alteration of the silicone curing procedure in 1965. Thromboembolic rates are acceptable in the anticoagulated patient while prosthetic thrombosis is not a grave threat in the non-close clearance device. Incidence of endocarditis is not particularly different from that associated with all nonbioprosthetic valves, although there is a much greater published volume of clinical experience concerning recognition and treatment of late prosthetic valve endocarditis in patients with caged ball valves than there is for any other replacement device. Perhaps the most serious disadvantage to caged ball design is its size. Its large spatial requirements have led to anatomic complications in patients with small aortic roots, isolated mitral stenosis, left ventricular hypertrophy, and double valve replacement, among others. Nevertheless, this is still the valve of choice in some centers.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Prosthetic heart valves: a review. 635 70

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

The progress of 128 patients with congenital aortic stenosis has been followed from one to 28 (mean 14) years. Fifty-eight underwent cardiac catheterisation, and 46 (36% of the total) required surgical treatment. Of these, 42 were under 20 years old. Additional cardiac lesions were noted in five. Infective endocarditis was encountered in four. The onset of symptoms or increasing evidence of left ventricular hypertrophy on the electrocardiogram were the principal indications for catheterisation. Two-dimensional echocardiography is now important in this context. There were four deaths in the 46 surgically treated patients; three of these were early and the fourth was a late death three years after operation due to a massive cerebral embolus complicating infective endocarditis. The 42 survivors of operation and the 82 unoperated patients have remained under long-term supervision. Further surgery was necessary in 12 of the 42 surgically treated patients--valve replacement in seven of them two to eight years after valvotomy, replacement of a calcified xenograft valve in three, and repeat operation in two because of recurrence of subvalvar obstruction. Aortic stenosis is not a benign condition in childhood and adolescence. Close supervision is necessary and when any deterioration is detected further investigation as a prelude to probable surgery is mandatory. This should not be embarked on lightly in childhood unless there are pressing indications, particularly in view of the serious disadvantages of valve replacement in childhood.
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PMID:The management of congenital aortic stenosis. 717 Jun 80

We describe the cardiovascular abnormalities found at autopsy in patients with AIDS and a description of the opportunistic infections in these cases studied between January 1988 and August 1993. There were 51 cases with such diagnosis. Pericardial effusion appeared in 9, pleural effusion in 7, myocarditis in 5, 7 with pericarditis, endocarditis in 6, left ventricular hypertrophy in 20, right ventricular hypertrophy in 21 and evidence of atherosclerosis in 15. Thus, data of cardiovascular damage was present in 42.7% of our patients. The cardiovascular abnormalities in this group are common, in contrast to the paucity of clinical findings. Diagnosis of cardiac pathology was made in only 12% of them. So in every case with diagnosis of AIDS, a careful clinical examination and cardiac diagnostic oriented tests must be done for detection of these abnormalities.
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PMID:[The autopsy findings in 51 cases of AIDS with cardiovascular damage]. 784 Jul 32

A stentless porcine aortic valve was used for aortic valve replacement in 123 patients from 1987 to 1993. The mean age of 86 men and 37 women was 61 +/- 12 years. Most patients had aortic stenosis; one-third had coronary artery disease and six had mitral valve disease. The stentless valve was secured in the subcoronary position by the same technique used for a freehand aortic valve homograft. The size of valve was based largely on the diameter of the sinotubular junction of the aortic root. The mean valve size was 26.5 mm (range 19 to 29 mm) and 87% were 25 mm or larger. Two operative deaths occurred, one the result of myocardial infarction and the other the result of infective endocarditis. Patients have been followed up from 3 to 77 months, mean 22 months. Three late deaths, none related to the valve, have occurred. The actuarial survival at 6 years was 91% +/- 4%. Four transient cerebral ischemic events have occurred, but two patients had extracranial cerebrovascular disease. One patient had endocarditis late in the postoperative period and required reoperation. All patients had Doppler echocardiographic studies before discharge from the hospital, 3 to 6 months later and annually. Only 15 patients have aortic insufficiency, trivial in 6 and mild in 9. The peak and mean systolic gradients decreased significantly during the first 3 to 6 months after implantation (p < 0.001), and the effective valve areas increased significantly during this time interval (p < 0.001). This improvement in valve hemodynamics is believed to be due to remodeling of the aortic root and regression of left ventricular hypertrophy. The results of aortic valve replacement with this stentless bioprosthesis have been excellent and justify its continued use in older patients.
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PMID:Aortic valve replacement with a stentless porcine aortic valve. A six-year experience. 798 72

Autopsy data of 58 cases (1958-1986) was analysed for cardiac lesions. The cases were divided into 2 groups; paediatric (23) and adult (35). The heart was normal in 8.7% and 20.5% of the above groups respectively. Rest of the cases showed left ventricular hypertrophy with variable dilatation. Obstructive lesion in the aorta and or renal arteries was present in 91.3% of paediatric and 80.0% of adult cases. Congestive cardiac failure was very common in paediatric group (60.8%) and was not seen in absence of obstructive lesion in the aorta or renal arteries. Histologically the aortic lesion was healed in 70% and 50% of paediatric and adult cases. The commonest additional lesion found, was coronary artery involvement in 11 cases (17%). Ostial stenosis was noted in 7 cases, including 2 in paediatric age group. Epicardial coronaries were involved in 4 cases with infarcts in 4. Aortic incompetence was rare (3.4%). Associated rheumatic mitral stenosis was seen in 2 and healed infective endocarditis in one. Histologically apart from the above mentioned lesions the myocardium showed essentially a response to hypertension. Focal lymphocytic infiltration was seen in 2 children and tuberculosis myocarditis in 3 adults. No case of any other type of myocarditics or cardiomyopathy was seen. In conclusion hypertension and coronary artery disease are the main factors responsible for myocardial failure but additional related or unrelated factors were present in 15.0% cases.
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PMID:Cardiac lesions in non-specific aorto-arteritis. An autopsy study. 798 78

Since March 1993 the Toronto SPVTM bioprosthesis has been implanted in 100 patients. Our prospective study evaluated the echocardiographic valve characteristics and the influence of the echocardiographic assessment on surgical technique. Transesophageal echocardiography (TEE) was applied before and during surgery, and transthoracic echocardiography (TTE) postoperatively. The average valve size implanted was 26.5 mm. Follow up was complete in 74 patients at six months and in 38 patients at one year. Pre-cardiopulmonary bypass (CPB) TEE valve sizing was accurate by +/- 1 mm in 81 patients as compared to mechanical sizing. Post-CPB valve closure was concentric in 99 patients. Minimal aortic incompetence was present in seven patients at one week, in two patients at six months and in one patient at one year. Mean pressure gradients ranged from 7.7 to 11.1 mmHg postoperatively. Overall mortality was 4%. One patient with non-structural dysfunction and another with endocarditis at one year postoperatively were reoperated successfully. At follow up there was a significant decrease in transvalvular pressure gradients and an increase in valve orifice areas. In 32 patients a decrease in left ventricular posterior wall (LVPW) hypertrophy was found (p < 0.001). There was a decrease in tissue depth and recurrence of the dynamic movement of the aortic root. It is concluded that TEE valve sizing is reliable for early valve selection. Valve incompetence is not a clinically relevant issue using the oversizing technique. Improved hemodynamics at follow up can be explained by remodeling of the aortic root and by a decrease in left ventricular hypertrophy. The excellent hemodynamic profile, resembling native aortic valve function, is impressive and has to be confirmed by long term evaluation.
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PMID:Hemodynamic assessment of the stentless Toronto SPV bioprosthesis by echocardiography. 800 Jun 9


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