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

In the surgical treatment for active infective endocarditis (IE), perivalvular leakage is the most severe complication. We had a 42-year-old man who had active IE and a giant vegetation in the aortic valve, and a small mycotic aneurysm in the left ventricular outflow tract. Other operative observations included slight redness and a decrease in the reflex of the annular endocardium. We made a patch closure of the mycotic aneurysm, and aortic valve replacement using the Teflon felt reinforcing method. In the postoperative course, he had a pacemaker implantation with complete AV block. Postoperative pathological examination revealed inflammatory cells and plasma infiltration, and edematous change of the interstitial tissue around the cusp surface and annular side of the resected valve. These pathological changes could explain the redness and the decrease in the reflex of the annular endocardium. The edematous changes of the annular tissue might be the cause of postoperative perivalvular leakage. Reinforcement of the prosthetic valve with Teflon felt might be a useful method to prevent perivalvular leakage. There is, however, the possibility of acceleration or elongation of infective endocarditis. In our experiences of the surgical treatment for active IE, we performed valve replacement using Teflon felt in 6 patients, and not using in 27 patients. The mean period until CRP had been normalized was no significant difference between both groups (mean days using Teflon felt were 63.5 days, and not using were 75 days).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A useful method for the surgical treatment of active infective endocarditis--a case report using the Teflon felt reinforcing method]. 163 46

A total of 99 cases of viridans streptococcal endocarditis encountered during the period of 1973 and 1990 at the Veterans General Hospital-Taipei were reviewed to evaluate its prognostic factors. Applying strict clinical and laboratory criteria, 24 cases were categorized as definite, 44 probable, 23 possible and 8 likely. The symptoms were frequently subtle and atypical but initial laboratory tests gave useful indications: 69.1% with leukocytosis, 78% with anemia, 58.5% with elevation of LDH level, 88.9% with elevation of ESR value and 100% with elevation of CRP level. Furthermore, 32.4% of the cases demonstrated proteinuria and 67.4% microscopic hematuria. Seventy-three of the subjects had a history of underlying heart disease, predominantly rheumatic heart disease. Histological examination and echocardiography revealed that 51 patients suffered from vegetative endocarditis, 7 (13.7%) of whom were found to have anatomically confirmed vegetations without initial echocardiographic evidence, Vascular events were seen in 61 cases (61.6%): peripheral stigmata (32 cases), cerebral vascular accidents (17 cases), pulmonary embolism (10 cases) and others (2 cases). The overall mortality rate was 18.2%. Congestive heart failure with embolization was the most common cause of death in this group. The presence of vegetation was not well correlated with embolic events. There was no statistically significant association between the mortality and the following characteristics: age, sex, underlying heart disease, evidence of echocardiographically detected vegetations, major surgical intervention and recurrent cases except for embolic events (p less than 0.01). In conclusion, viridans streptococcal endocarditis complicated embolic events usually presented with a fulminant course and a grave outcome.
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PMID:Overview of viridans streptococcal endocarditis: clinical analysis of 99 cases. 165 35

A 47-year-old man was hospitalized in May, 1990, because of breathlessness and continuous fever which appeared about 4 weeks after he had had his periodontic tooth removed in December, 1989. He had been diagnosed as having ventricular septal defect (VSD) at the age of 6 years. When he was hospitalized, he was in a condition of class IV by NYHA classification, with a white blood cell count of 17,300/mm3, an increase in CRP, a red blood cell sedimentation rate of 108 mm/hr, and positive alpha-streptococcus in blood culture. His cardiothoracic ratio was 64% with signs of pulmonary congestion on a chest X-ray film. Echocardiography revealed the presence of VSD and huge vegetations on the tricuspid, mitral and aortic valves. He was considered to have active infective endocarditis (AIE) which had presumably been provoked by VSD and the tooth removal. Penicillin G at a daily dose of 20 million units and gentamicin at a daily dose of 80 mg were intravenously administered to treat the alpha-streptococcus infection for about 4 weeks. Furosemide was used for congestive heart failure. Since, although his cardiac function appeared to have been improved, the signs and symptoms of the infection persisted, triple valve replacement for the tricuspid, mitral and aortic valves and patch closure of the VSD were performed 4 weeks after the hospitalization. The operation revealed inflammatory lesions extending from the endocardium of the right ventricle to the mitral valves through the VSD, and huge vegetations on the tricuspid, mitral and aortic valves. The operation was successful and the inflammatory areas gradually disappeared.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of ventricular septal defect associated with active infective endocarditis which was successfully treated by triple valve replacement and ventricular septal defect patch closure]. 174 71

Progress in chemotherapy and cardiosurgery has remarkably decreased the mortality due to infective endocarditis (IE) in recent years. In chemotherapy for IE, parental administration of antibiotics has been used routinely, the patients suffer from the psychological and physiological burden due to frequent injections and long period of therapy, even though the therapy for IE is successful. In this report, we present a case of IE caused by S. mitis, which was remarkably improved by oral administration of AMPC. A case, 69. y.o. female. She felt like a common cold and visited a G.P. Cardiomegaly was pointed out and positive inflammatory findings in serological examination were found. A low grade fever continued, and she was admitted to the hospital. Blood cultures were positive for S. mitis. For further examination, she was transferred to the university hospital. Based on the extensive blood cultures and cardioechogram, she was diagnosed IE caused by S. mitis. Because there were no symptoms of heart failure, we decided to try oral administration of AMPC, 4 g/day or 6 g/day at an interval of 6 hours. On the second day of therapy, the blood culture turned to be negative for pathogens, and on the fourth day body temperature became normal. On about the 60th day, the CRP finding became negative. Concentrations in the serum of AMPC were more than 10 folds of AMPC-MIC (0.5 microgram/ml) for S. mitis. The patient, however, suffer from complications of lung embolism and was operated for exchange of heart valves. After surgery, she has been well without any symptoms from IE.
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PMID:[A case of infective endocarditis (IE) improving with orally administered amoxicillin (AMPC)]. 250 99

An analysis was made of 91 cases of infective endocarditis (IE) with regard to causative organisms and their sensitivities to various antibiotics, the clinical features of the disease, the laboratory test results and other items were important in establishing a diagnosis of IE. The number of cases of IE has shown a tendency to increase in recent years, particularly in the number of elderly patients, and the ratio of total cases consisting of prosthetic valve endocarditis (PVE) has shown a sharp increase. The most common causative organism is still Streptococcus viridans, but there has been an increase in the incidence of IE due to benzyl-penicillin-resistant strains of Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis and other fastidious organisms. The percentage of underlying diseases represented by combined valvular diseases has been increasing, while the primary known cause of the infection of IE was dental treatments. A positive value for CRP, an accelerated value for ESR, leukocytosis, anemia, a decrease in serum Fe, a positive value for RA-T, were all parameters which showed a high correlation with IE, and these should be useful in establishing the diagnosis of IE. The use of cardioechography to detect cardiac vegetation is important in relation to establishing the diagnosis and prognosis of IE, and the evaluation of the therapeutic results.
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PMID:Current diagnosis of infective endocarditis. 389 10

The authors report a case of bacterial intracranial aneurysm associated with infective endocarditis. A 48-year-old male was admitted on March 26, 1994, with complaints of difficulty in speaking and mild swelling of the right leg following mild fever. On examination he showed motor aphasia and mild weakness of the right upper and lower limbs. Cardiac auscultation revealed a grade 3/6 holosystolic murmur. Laboratory data revealed signs of infection through white blood cell count and CRP. Enterococcus faecalis was isolated from the blood culture at the time of admission. A computerized tomographic (CT) scan and magnetic resonance (MR) imaging showed a round mass with perifocal edema. Angiography revealed an aneurysm from the precentral artery of the left middle cerebral artery. A mycotic aneurysm due to bacterial endocarditis was diagnosed. The patient was treated with high doses of antibiotics. However, angiography 2 weeks after the initial study demonstrated the enlargement of the aneurysm and severe narrowing of the angular artery. On April 19, excision of the aneurysm was performed. Operative findings showed degeneration and thickening of the walls of the aneurysm. After the operation, antibiotic therapy was continued. The patient was asymptomatic upon discharge and has continued to do well. Repeated angiography on September 12 showed no further aneurysm. There is a danger of rupture in mycotic aneurysm due to bacterial endocarditis. It is important to repeat angiography and to manage the primary disease. If an aneurysm enlarges with serial angiography, it should be treated surgically without further delay.
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PMID:[Bacterial intracranial aneurysm associated with infective endocarditis: a case showing enlargement of aneurysm size]. 747 21

A case of perforated mitral valve aneurysm following aortic valve replacement associated with infective endocarditis was reported. The patient was a 29-year-old man, who was suffering from high fever, Osler's nodules and headache. A brain abscess was recognized in a computed tomography and 3rd grade aortic regurgitation was recognized in echocardiogram and aortography. Hematological studies suggested the inflammation and gram-positive cocci was incubated from his arterial blood. Then infective endocarditis with aortic regurgitation was diagnosed. AVR was performed following 8 weeks treatment with antibiotics, when he had negative CRP and his blood culture. After the operation, he was received the intravenous antibiotic therapy for 6 weeks and oral antibiotic drugs was given following his hospital discharge. At 6 months after AVR, mitral valve aneurysm was recognized in his echocardiogram. At 30 months after AVR, the perforation of it was revealed and mitral valve replacement was performed with his negative blood culture. The patient was discharged 28th day after MVR. There has been no active inflammation from his first hospital discharge and following days, the mitral valve aneurysm and the perforation was caused by weakened tissue of the anterior mitral leaflet due to sibilant inflammatory change.
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PMID:[A case of perforated mitral valve aneurysm following aortic valve replacement associated with infective endocarditis]. 805 30

42-year-old man, who had been febrile for about a month, was admitted to our hospital. Laboratory testing showed leukocytosis and high titer of CRP. Streptococcus sanguis II was detected in his blood culture. According to the echocardiogram, he had a vegetation on the anterior mitral leaflet, so he was diagnosed as having infective endocarditis. Antibiotic susceptibility test using the disc method showed (3+) response to penicillin G. After intravenous administration of 20 million units of penicillin G for 3 weeks, a new vegetation appeared on the posterior mitral leaflet although the one on the anterior mitral leaflet had disappeared. Imipenem/cilastatin was administered until the acute phase reactants became negative. But the vegetation did not disappear, so he had vegetectomy. This is the first case report of infective endocarditis in which a new vegetation appeared on a different site despite the disappearance of the first lesion during chemotherapy.
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PMID:[A case of infective endocarditis in which a new vegetation appeared on a different site during chemotherapy]. 835 41

In a prospective study of 65 patients with S. aureus septicemia, the clinical value of measuring serum IL-6 and lactoferrin levels was assessed and compared with CRP levels and WBC count. 20/65 (31%) patients had a CRP value < or = 100 mg/l on admission and 10 (50%) and 11 (55%) of these had serum levels of IL-6 > 100 pg/ml or lactoferrin > 2.0 mg/l, respectively. 41/64 (64%) patients had a WBC count < or = 15.0 x 10(9)/l and the corresponding figures for increased IL-6 and lactoferrin values were 29 (71%) and 21 (51%) patients, respectively. The high concentrations of IL-6 and lactoferrin on admission decreased rapidly during the hospital stay, better reflecting the clinical course than CRP and WBC count. Patients with endocarditis showed higher IL-6 levels and body temperatures both on admission and during the first days of hospitalization compared with patients without endocarditis.
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PMID:Interleukin-6, C-reactive protein, lactoferrin and white blood cell count in patients with S. aureus septicemia. 865 73

Dissection of the interventricular septum is an uncommon manifestation, which is rarely associated with infective endocarditis, aneurysm of sinus of Valsalva and thoracic trauma. We report a 34-year-old male case with aorto-left ventricular communication due to infective endocarditis. The patient had chief complaints of dyspnea on exertion and precordial discomfort. Preoperative laboratory data showed normal white blood cell counts, a slightly elevated CRP, and negative blood culture in bacterial examinations. Echocardiogram revealed progressive dissection of the interventricular septum and stenosis of the left ventricular outflow tract. Disturbance of conduction including progressive atrioventricular block and bundle branch block were found in the electrocardiogram. The dissection extended over 2 x 2 x 2.5 cm in diameter, with an entry located at the basis of the right coronary cusp and reentry communicated to the left ventricle. Operative procedures included the aortic valve replacement with prosthetic valve due to severe inflammation, in addition to resection of the dissecting cavity. Pathological examination of the resected tissue accorded with infective endocarditis in active phase, showing necrosis, small cell infiltration and microabscess. However, a bacterial colony was not found in the surgical specimen. Postoperative course was uneventful and the patient was discharged in satisfactory conditions.
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PMID:[Dissection of the interventricular septum with aorto-left ventricular communication due to infective endocarditis--report of a rare case]. 866 75


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