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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

Prosthetic valve endocarditis caused by Pseudomonas aeruginosa is refractory to medical treatment alone and early valve replacement is necessary. We describe a 40-year-old patient in whom endocarditis developed in the early postoperative period, and reoperation was not considered feasible. Ciprofloxacin was administered orally in order to suppress bacteremia for 36 months. Long-term oral ciprofloxacin may provide an opportunity in the treatment of prosthetic valve endocarditis caused by Ps. aeruginosa in patients who are unfavorable candidates for reoperation.
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PMID:Long-term oral ciprofloxacin in the treatment of prosthetic valve endocarditis due to Pseudomonas aeruginosa. 128 15

Prosthetic valve endocarditis is a formidable complication following cardiac valve replacement. Surgical intervention has resulted in a significant reduction in mortality when certain complications prevail. We report two such cases of prosthetic valve endocarditis in which the use of transesophageal echocardiography permitted close surveillance during medical therapy and thus avoided the need for surgical intervention. Therefore, with the improved ability to monitor disease progression with transesophageal echocardiography, nonsurgical management of prosthetic valve endocarditis remains an option.
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PMID:Utility of transesophageal echocardiography in the conservative management of prosthetic valve endocarditis. 144 10

Prosthetic valve endocarditis (PVE) remains an uncommon but serious complication of cardiac valve replacement. We analysed several risk factors (active or healed, early or late endocarditis, congestive heart failure, arterial emboli etc.) in order to identify the factors which may predict bad outcome. The overall mortality rate was 46.8% (15/32 patients). There was a significantly higher mortality rate in patients with early endocarditis (80%) than in those with late endocarditis (38%) (p less than 0.01). In the group of patients who underwent reoperation, the mortality rate was higher in those with active endocarditis (70%) than in those with healed endocarditis (28.5%) (p less than 0.05). We believe that combined medical and surgical treatment is the best management for bioprosthetic valve endocarditis, with the institution of appropriate preoperative antibiotic therapy, to attempt to achieve sterilization.
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PMID:Bioprosthetic valve endocarditis: factors affecting bad outcome. 175 3

Prosthetic valve endocarditis (PVE) has existed for about 30 years. Its incidence and mortality have decreased compared to the '60s, but they are still remarkable. The distinction between early and late forms of PVE is still justified, only if considered critically. At present the incidence of early PVE is 1% or less. It is caused mainly by staphylococci, Gram-negative bacilli, and fungi, which infect the prosthesis during or immediately after surgery; it carries a mortality of 30-60%. The incidence of late PVE is approximately 1% per year; pathogenesis and clinical features are similar to infective endocarditis (IE) on native valves. Streptococci are the most frequent causative organisms and current mortality is 25-35%. The diagnosis of PVE can be difficult; a strong clinical suspicion, blood cultures, and echocardiography are the most valuable tools. The antibiotic treatment follows the general indications for IE, but in PVE the associations of 2 or more antibiotics are the rule and need to be used according to established protocols. The occurrence of prosthetic dysfunction, para-annular abscesses, and embolism is frequent in PVE and makes prognosis worse. In all cases of complicated PVE or in those due to resistant organisms, an early reintervention must be associated to medical therapy. The surgical treatment of PVE often implies difficult and complex procedures, but early and long-term results are better than those obtained with medical treatment alone. Pharmacological prevention of embolism remains an unsolved problem. The prophylaxis of early PVE has made remarkable progress in the last 20 years and present results appear hard to improve. The prophylaxis of late PVE requires a more widespread awareness of this problem even outside the setting of cardiology and cardiac surgery.
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PMID:[Infective endocarditis in valve prostheses]. 184 61

Prosthetic valve endocarditis is an infrequent but serious complication of valve surgery. It occurred in 25 (3.2%) of 772 patients who received aortic, mitral or double valve replacement in 1971-1987. The total follow-up time was 3,976 patient years, giving an incidence of 0.63/100 patient years. Staphylococci were the most common of the cultured organisms in early and late infections-60% and 64%, respectively. The endocarditis was disclosed at autopsy in two cases. Treatment was antibiotics alone in 11 cases, and surgery was required in 12, the indication always being congestive heart failure. C-reactive protein level fell more rapidly than erythrocyte sedimentation rate in response to antibiotic or surgical management. The mortality rate was 73% in the antibiotic group and 33% in the surgical group. The findings demonstrated that an infected valve prosthesis should be replaced without delay if complications develop.
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PMID:Prosthetic valve endocarditis. 194 6

A 60-year-old female with mitral stenosis developed prosthetic valve endocarditis due to methicillin resistant staphylococcus aureus septicemia 3 weeks after mitral valve replacement. In vitro test disclosed susceptibility to minocycline and clindamycin. Despite large amount of intravenous administration, progressive heart failure due to massive perivalvular leakage occurred as a consequence of persisting infection. An emergent operation revealed valve detachment of the posterior portion resulting from ring abscess formation. A mitral prosthesis with a Gore-Tex flange was implanted partially in the left atrium just above the mitral ring and sutured to the atrial wall. Postoperative relapse was not detected even after discontinuing antibiotics. Prosthetic valve endocarditis due to methicillin resistant staphylococcus aureus is highly resistant to antibiotic therapy and likely to develop valve ring abscess. Prompt surgical treatment is mandatory in this situation.
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PMID:[A case report of early prosthetic valve endocarditis due to methicillin resistant Staphylococcus aureus infection--an experience of intraatrial implantation of mitral prosthesis with a Gore-Tex flange]. 196 Apr 64

Fifty cases of aortic valve endocarditis during a 6-year period between 1982 and 1988 were reviewed. Twenty-three (46%) had aortic root complications by way of aortic root abscess or mycotic aneurysm in the perivalvular area. Patients with root complications were grouped into the aortic root abscess (ARA) group and those without into a non root abscess (NARA) group. Prosthetic valve endocarditis dominated in the ARA group (12 and four cases of prosthetic valve infection in the ARA and NARA groups, respectively; P less than 0.01). Surgical mortality was significantly higher at 13.6% in the ARA group as opposed to 2.2% in the NARA group (P less than 0.05). Post-operative aortic regurgitation was present in 8 (57%) of 14 patients in the ARA group surviving surgery but in only two (8.7%) of 23 patients in the NARA group (P less than 0.03). We conclude that aortic root complications are a frequent occurrence in aortic valve endocarditis, lead to an increased operative mortality and is associated with a high incidence of post-operative aortic regurgitation.
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PMID:Aortic root complications of infective endocarditis--influence on surgical outcome. 204 59

Advances in chemotherapy and surgery have significantly improved the outcome of infective endocarditis, but the disease remains a therapeutic challenge with an overall mortality of 20%. More cases of infective endocarditis seen today are associated with prosthetic heart valves, intravenous drug abuse, or complications of medical and surgical technology. Prosthetic valve endocarditis occurs in 1% to 4% of patients with prosthetic valves. Echocardiography is not a precise diagnostic test for endocarditis, but it helps detect a variety of cardiac lesions, including valvular incompetence, annular ring abscesses, and sometimes vegetations. Serum bactericidal titers are predictive of neither cure nor treatment failure. The principal indication for urgent surgical intervention is acute valvular dysfunction. Other considerations for surgery include evidence of myocardial invasion, infection by antibiotic-resistant organisms, and large vegetations. For patients at risk of infective endocarditis, antibiotic prophylaxis during invasive procedures is an accepted practice.
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PMID:Diagnosis and management of infective endocarditis. 226 67

This article presents the University of Alabama experience with homograft aortic valve replacement for prosthetic valve endocarditis. Of 117 patients who have undergone homograft aortic valve replacement since 1981, there has been a total of 22 patients who underwent operation for endocarditis. Sixteen were isolated valve replacements, three combined with other procedures, and three were aortic root replacements. When placed in a setting of active endocarditis, there have been no reoperations for endocarditis of the homograft valve. Surgical techniques are presented for the freehand sewn homograft as well as aortic root replacement. Prosthetic valve endocarditis is a highly lethal event and when aortic valve replacement is advised in this setting, we believe a homograft aortic valve should be implanted whenever possible.
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PMID:Surgical treatment of prosthetic valve endocarditis with homograft aortic valve replacement. 252 16


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