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

Infective endocarditis is uncommon in young children, especially in the absence of structural heart disease. We report the case of a 2-year-old boy who presented with acute rupture of the mitral valve chordae 6 weeks after an episode of Fusobacterium necrophorum septicemia. His heart had been structurally normal before. Mitral valve replacement was successfully performed. This is the first recorded case of endocarditis in a child caused by necrobacillosis.
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PMID:Endocarditis with acute mitral regurgitation caused by Fusobacterium necrophorum. 151 43

Infective endocarditis is associated with significant morbidity and mortality. Valvular destruction and congestive heart failure are more common in patients with echocardiographically detectable vegetations. In addition, spontaneous platelet aggregation is increased when vegetations are present on cardiac valves. The aim of the study was to assess the prognostic value of spontaneous echo contrast (SEC) imaging, as SEC is supposed to reflect red blood cell aggregates stimulated by platelet activity. We studied 293 patients with clinical signs of infective endocarditis. Vegetations, attached to the aortic or mitral valve, were found in 130 patients (44.4%) who were followed for a mean period of 12 months. In 34 of these 130 patients (26.2%) SEC was imaged during the initial transesophageal echocardiographic examination. In these patients SEC indicated a prolonged healing of infective endocarditis with a specificity of 91.2%, a sensitivity of 77.3%, a positive accuracy of 77.3%, a negative accuracy of 74.3%. Multivariate analysis revealed that SEC is a risk factor for valve replacement (p less than 0.001) and for embolic events (p less than 0.001), less for mortality (p less than 0.01), and lowest for abscess formation (p less than 0.05). The dose of ADP to induce half-maximal platelet aggregation was significantly lower in patients with SEC (0.71 +/- 0.15 microliters) than without SEC (1.05 +/- 0.12 microliters; p less than 0.05), implying an increased spontaneous platelet aggregation in the presence of SEC. Our data provide evidence that systemically activated coagulation plays an important role in infective endocarditis. SEC, the echocardiographic implication of an increased platelet aggregation, predicts complications such as thromboembolic events and the need for surgery and is closely related to the prolonged healing period of infective endocarditis. In addition to demonstrating vegetations, transesophageal echocardiography provides information helpful in assigning patients to a high-risk subgroup. Transesophageal echocardiography may play an important role in assessing the clinical outcome of these patients.
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PMID:Spontaneous echo contrast imaging in infective endocarditis: a predictor of complications? 152 42

Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a significantly higher incidence of embolic events than vegetations on aortic valves (25% vs 9.7%). The incidence of abscess formation was higher in aortic than in mitral valve endocarditis (6% vs 0%), as were the need for surgical intervention (11% vs 5.5%) and mortality (1.6% vs 0%) respectively). Bivalvular endocarditis was associated with an increased rate of complications: embolism (50%), abscess formation (15%), surgery (35%) and mortality (10%). By multivariate analysis, echocardiographically accessible risk factors for subsequent embolism were a vegetation size of more than 10 mm and mitral valve involvement. Risk factors associated with in-hospital fatality were embolism, a vegetation size of more than 10 mm, and Staphylococcus aureus infection. Our data suggest that the site influences both the rate and the type of complications. Precise echocardiographic visualization of vegetations helps to stratify patients into a high-risk sub-group, perhaps warranting early prophylactic surgical intervention. Transoesophageal echocardiography may play an important role in assessing the clinical outcome for these patients.
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PMID:Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis. 160 Sep 80

The usefulness of transesophageal echocardiography (TEE) in cardiovascular clinical practice is assessed. Seven hundred transesophageal studies were performed between November 1989 and October 1991. One hundred and seventeen studies carried out during the follow-up of treated non-acute pathologies were excluded. The study could not be made in 6 patients. The most frequent indications of TEE were aortic pathology study, 120 (21%), infective endocarditis, 72 (13%), origin of systemic embolisms, 66 (11%), and mitral pre-valvuloplasty and intensive care, 64 (11%). The incidence of pathologic findings on TEE not diagnosed by conventional echocardiography was 32% (182/577). The incidence of pathologic findings with therapeutic implications was 15% (85/577). Indications showing a greater incidence of pathologic findings with therapeutic implications were: 1) thoracic aorta pathology, 42 (35%); 2) mitral prostheses disfunction, 8 (19%), and 3) mitral pre-valvuloplasty, 10 (16%). Infective endocarditis, intensive care studies and congenital cardiopathies had an incidence of 12%. TEE findings in the study of intracardiac masses, the origin of peripheral embolisms and mitral insufficiency had little influence (less than 5%) on the management of the patient.
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PMID:[The performance of transesophageal echocardiography in clinical cardiovascular practice]. 160 33

Infective endocarditis remains a life-threatening condition, although the number of deaths due to this disease has fallen by 80% over the past 50 years. Dental undergraduate and postgraduate teaching rightly emphasises the use of prophylactic antibiotics for those patients most at risk of developing the condition. However, the types of patients at risk have also changed with the increased use of antibiotics and availability of heart surgery. While oral microorganisms may be incriminated in infective endocarditis, causal organisms arise from a number of other sites and in many cases the portal of entry is unknown. It is now thought that the proportion of cases that are apparently dentally related is probably smaller than previously believed. This article concentrates on the mechanisms by which this disease occurs, an area which is often poorly understood by undergraduates and postgraduates alike. An extract is included from the Lancet, which provides the most recent recommendations for endocarditis prophylaxis.
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PMID:The aetiology, epidemiology, pathogenesis and changing pattern of infective endocarditis, with a note on prophylaxis. 161 55

Infective endocarditis remains even today a potential lethal disease. The most frequent bacterial agents are viridans streptococci, staphylococci and enterococci. Left-sided endocarditis predominates except for patients with drug addiction. Modern recommendations of treatment are based on in vitro studies, experimental data from the animal model and clinical studies. Antimicrobial therapy should be parenteral and bactericidal in character. Detailed recommendations for treatment are given. Progressive heart failure, persistent bacteremia and repeated embolism are the most important reasons for surgical intervention. Modern prevention is performed as single or short-term prophylaxis for about sixteen hours. Simple practicability as well as handing out of guidelines to the patient will contribute to improved acceptance.
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PMID:[Therapy and prophylaxis of infectious endocarditis]. 185 6

Infective endocarditis is a serious disease and should be, if possible, prevented. Two risk groups are classified in relation to the patient's underlying cardiac lesions. At high risk are patients with prosthetic valves or with a previous infective endocarditis. Patients with congenital and acquired heart disease, mitral valve prolapse with regurgitation and hypertrophic obstructive cardiomyopathy are at moderate risk. Patients of these two groups should receive antibiotic prophylaxis before dental or surgical procedures that cause bacteremia. For patients at moderate risk a single dose of an orally administered antibiotic should be given one hour before the procedure (e.g. amoxicillin 3 g for procedures of the oropharyngeal, gastrointestinal or genitourinary tract, where the causitive agents of endocarditis are Viridans streptococci or enterococci). Multiple doses are recommended for patients at high risk. The combination of amoxicillin and gentamicin (vancomycin and gentamicin in penicillin-allergic patients) offers the widest margin of safety in high-risk patients.
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PMID:[Antibiotic prevention of bacterial endocarditis]. 185 64

Cardiac involvement is being identified more often clinically and at autopsy in patients with AIDS. Recent estimates suggest that in the United States as many as 5000 patients per year may have cardiac complications resulting from HIV infection. Patients with AIDS may have pericardial, myocardial, and/or endocardial disease. Pericardial tamponade and/or constriction may be related to neoplasms, infections, or nonspecific effusions. Myocardial dysfunction may result from specific neoplastic infiltration or myocarditis. Particularly intriguing is the role of HIV-1 in the nonspecific myocarditis and dilated cardiomyopathy that occurs in patients with AIDS. As in other debilitating conditions patients with AIDS can have nonbacterial thrombotic endocarditis. Infective endocarditis may be a complication, especially in AIDS associated with intravenous drug abuse. Most patients with AIDS have no overt clinical evidence of cardiac disease. When cardiac dysfunction does develop, the signs and symptoms are often misinterpreted to be the result of noncardiac causes (pulmonary failure or infection) which can mimic heart failure. This review is intended to alert the reader to the cardiac manifestations of AIDS, which present a number of diagnostic and therapeutic challenges.
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PMID:Cardiac manifestations of acquired immune deficiency syndrome: a 1991 update. 185 38

Aneurysms of the left ventricle may be congenital or may occur after a myocardial infarction, trauma, or endocarditis. Infective endocarditis can cause destructive injury to the heart in various ways. This report describes the formation of an aneurysm of the left ventricle from trauma of a bacterial vegetation of the mitral valve. Early recognition by echocardiography and magnetic resonance imaging led to successful repair and prevented a catastrophic result.
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PMID:Successful repair of a submitral left ventricular infected pseudoaneurysm. 186 56

To evaluate the difference in the frequency of complication of mitral valve prolapse (MVP) according to sex in subjects aged 60 years and older, 543 patients (218 men and 325 women) who were diagnosed as having MVP by echocardiography at the Lahey Clinic Medical Center were studied. Three hundred and fourty eight patients had no complication of MVP (male vs female = 129:219). Infective endocarditis occurred in 20 patients (male vs female = 13:7). Rupture of chordae tendineae occurred spontaneously in 29 patients (male vs female = 20:9) and were associated with infective endocarditis in 8 other patients (male vs female = 6:2). Eighteen patients required mitral valve surgery for severe mitral regurgitation. The frequencies of these complications were higher in males than those in females. Cerebral ischemic events were encountered in 54 patients. There was no significant difference in the frequency between male and female. In conclusion, MVP in elderly men might be at for cardiac complication.
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PMID:[Frequency of complications of mitral valve prolapse in the elderly]. 187 Feb 81


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