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

An antibiotic prophylaxis of infective endocarditis is recommended in patients at high risk for infective endocarditis (patients with valvular prosthesis, or cyanogen congenital or obstructive cardiac defect) or those with aortic, mitral or tricuspid valvulopathy, a non-cyanogen congenital or obstructive cardiac defect. Dental procedures (except treatment for superficial decay and preparation for the fitting of prostheses to teeth with intact pulp) are to be carried out under local antisepsis and a prophylactic antibiotics, such as 3 g of oral amoxicillin or in case of allergy to penicillin, 600 mg of clindamycin or 1g of pristinamycin, administered one hour prior to the procedure. A similar prophylaxis is recommended for the procedures on the upper respiratory tract. Amoxicillin, or vancomycin or teicoplanin are recommended for procedures under general anaesthesia. For surgery on the intestinal or urogenital tract, regimens combine amoxicillin with gentamicin, or in case of allergy to penicillin, vancomycin or teicoplanin with gentamicin.
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PMID:[Prevention of infectious endocarditis]. 777 15

A patient with an intracranial fourth ventricular cyst developed right heart endocarditis from an infected ventriculoatrial shunt inserted previously. Investigation revealed pneumonic involvement of the right lung, moderate tricuspid regurgitation, mild pulmonary artery hypertension, and a large right atrial vegetation. The shunt was removed and treatment of endocarditis started, before undertaking excision of the cyst under general anesthesia. During the operation there was a sudden deterioration in the patient's condition rapidly leading to death. Clinical features suggested intraoperative pulmonary embolism; both venous air embolism and a dislodged atrial vegetation were considered. However, in the absence of specific monitoring equipment and autopsy, the actual cause could not be ascertained. This clinical report highlights the anesthetic problems related to posterior fossa surgery in patients with right-sided endocarditis and suggests some possible management strategies.
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PMID:Posterior fossa surgery in postshunt endocarditis patients: some anesthetic issues. 808 Oct 98

Pregnancy carries substantial maternal and fetal risks in patients with uncorrected or palliatively corrected cyanotic congenital heart disease (CHD). In tricuspid valve Ebstein's anomaly, pregnancy is well tolerated. Maternal mortality in tetralogy of Fallot seems to be less than 10%, but it exceeds 50% in Eisenmenger's syndrome and primary pulmonary hypertension (PPH). Maternal hematocrit greater than 60%, arterial oxygen saturation lower than 80%, right ventricular hypertension, and syncopal episodes are poor prognostic signs. Maternal risk could be reduced by vaginal delivery. Continuous monitoring of arterial and central venous pressure, electrocardiography, and pulse oximetry are recommended for every anesthetic procedure. The use of a pulmonary artery catheter is controversial and probably should be avoided in parturients with cyanotic CHD or PPH. The choice of anesthetic technique and drugs per se is of secondary importance and should be governed by individual preferences. Titration of anesthetic drugs, general anesthesia with controlled ventilation, or, preferably, regional anesthesia with spontaneous breathing should be used cautiously to avoid worsening of the preexisting condition. Prevention of excessive erythrocytosis, volume and blood loss substitution, cardiocirculatory pharmacologic support, prophylaxis of infective endocarditis, and judicious use of anticoagulant drugs should be applied as indicated by the type and presentation of CHD. Poor outcome of pregnancy in PPH requires an early consideration of heart-lung or lung transplantation. Multidisciplinary team effort and prolonged monitoring in the intensive care unit are mandatory to ensure a favorable outcome for cyanotic CHD and PPH parturients.
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PMID:Cyanotic congenital heart disease and pregnancy: natural selection, pulmonary hypertension, and anesthesia. 837 15

The number of patients with congenital cyanotic heart disease who reach child-bearing age is increasing. This is partly a consequence of the high long-term survival and the haemodynamic benefits resulting from the Fontan procedure, which is used for the definitive palliation of such cyanotic heart disease as tricuspid atresia and single ventricle. However, so far little experience has been recorded with pregnant patients who have undergone right ventricular exclusion procedures. The particular physiology of a univentricular heart and a passive, non-pulsatile blood flow through the lungs has significant implications for the anaesthetic obstetric management of these patients. We report a case of successful pregnancy and caesarean delivery after a modified Fontan procedure. CASE REPORT. The patient was a 30-year-old pregnant woman with a singleton pregnancy. At the age of 20, after four palliative shunt operations, she had undergone a modified Fontan operation due to tricuspid atresia with a single ventricle, d-transposition of the great arteries, pulmonary atresia and a single atrium. Following the Fontan repair, she initially suffered from intermittent Wolff-Parkinson-White syndrome and isorhythmic AV dissociation. The pregnancy was uneventful, and caesarean section was scheduled for 32 weeks' gestation. Because of the increased risk of thrombosis, the patient was treated with s.c. heparin preoperatively; for this reason, epidural anaesthesia was excluded, though it may otherwise be preferred for such patients. Amoxicilline was used to prevent endocarditis. At the date of caesarean delivery her body weight was 54 kg and boy height, 155 cm. Before induction of anaesthesia, a central venous and a radial artery catheter were placed for invasive pressure monitoring. An exaggerated left lateral tilt position was used to avoid aortocaval compression. After careful preoxygenation, anaesthesia was induced with 24 mg etomidate, 1.5 mg norcuronium, and 75 mg succinylcholine. Halothane 0.5-0.7% in oxygen was used during the first few minutes of surgery. Central venous pressure under mechanical ventilation was 20 mmHg, while the heart rate varied between 70 and 90 bpm. Delivery was accomplished 8 min after the induction of anaesthesia. The Apgar scores after 1 and 5 min were 9 and 10, respectively. Anaesthesia was continued with fentanyl, midazolam and nitrous oxide 50%. The remainder of surgery was unevenful. The child is now 5 years old and healthy. The mother has a near-normal activity level and does not need any help to care for her child. DISCUSSION. After a modified Fontan repair, i.e. atriopulmonary or total cavopulmonary anastomosis, the pulsatile pulmonary blood flow is converted to a passive, non-pulsatile blood flow that depends critically both on the pressure gradient between right (RAP) and left atrial pressure (LAP) and on pulmonary vascular resistance (PVR). Thus, the maintenance of an adequate transpulmonary pressure gradient and avoidance of an increase in PVR are of major importance for the obstetric anaesthetic management in patients who have undergone right ventricular exclusion procedures. Impairment of venous return caused by slight caval compression or high airway pressure may reduce cardiac output more critically than in patients with a normal circulation. CONCLUSION. This case demonstrates that the haemodynamic consequences of pregnancy and of caesarean delivery under general anaesthesia can be tolerated in post-Fontan patients despite the absence of a contractile pulmonary ventricle.
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PMID:[Anesthesiologic aspects of pregnancy and delivery in a patient following a modified Fontan procedure ]. 876 69

Prophylaxis of infective endocarditis has been the subject of recommendations from most countries for several years. The basis of the recommendations is the administration of prophylactic antibiotics preceding a procedure at risk for patients with a known at risk cardiac disease. The antimicrobial agent is selected to be active against the main microorganisms causing bacteremia according to the type of at risk procedure. Furthermore, the choice and modalities of antibiotic prophylaxis are adapted to take into account a possible documented allergy to penicillin, the type of predisposing cardiac disease, the number of performed procedures and the requirement for general anesthesia. Future advances should concern the diffusion and application of these recommendations, and the appropriateness of these practices in terms of general cost benefit assessment.
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PMID:[Prophylaxis of infectious endocarditis]. 903 13

Transoesophageal echocardiography (TEE) is recognised as a semi-invasive technique that has an increasing impact as a diagnostic tool in anaesthesia and intensive care medicine. However, adequate assessment of TEE is based on knowledge of basic echocardiographic principles and their limitations and sufficient educational training of the user. TEE has an established role in various clinical circumstances. It often saves time-consuming investigations for the diagnosis of aortic injuries in trauma patients. It is also useful in patients undergoing cardiac valve repair or congenital heart surgery with regard to assessment of the operative success. In patients with severe hypotension TEE may identify the cause, and thereby facilitate successful patient management. Moreover, TEE has an impact on the diagnosis of endocarditis and pathologic findings within the heart and pericardial sac. TEE-associated diagnosis and decision-making may lead to an improved clinical outcome, which in turn may lead to subsequent cost reduction.
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PMID:[Transesophageal echocardiography in anesthesia and intensive care. The diagnostic importance of transesophageal echocardiography]. 929 82

We report a rare case of occult myocardial abscess due to group B Streptococcus that arose several weeks following streptococcal pneumonia. Hemopericardium was the initial presentation. Visualization of the abscess cavity was not possible with transthoracic echocardiography. A definitive diagnosis was made by left ventricular imaging during coronary arteriography. Rupture of the left ventricular free wall occurred during induction of anesthesia for operative exploration and debridement. Patch repair of the left ventricle was ultimately unsuccessful. Post-mortem examination revealed staphylococcal endocarditis of the mitral valve, valve ring abscess and multiple abscess cavities of the left ventricular free wall. A review of the clinical, diagnostic and therapeutic aspects of myocardial abscess is also presented.
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PMID:Penetrating mitral valve annular abscess. 942 31

The question concerning the effect of general anesthesia on oral contraceptives (OCs) is answered taking into consideration the modus operandi for the praxis. In theory, several interactions are possible between OCs and anesthesia: 1) the influencing of absorption through the ensuing anesthesia or postoperative vomiting; 2) the alteration of distribution volume; or 3) the accelerated elimination of active ingredients; 4) pharmacodynamic interaction between anesthesia and estrogens/progesterone at the receptor level; and 5) the influence on the endogenous hormone level through general anesthesia, which counteracts contraception. The absorption of oral antibiotics taken for endocarditis prophylaxis is not influenced 3-4 hours before a short narcosis. Similarly, undisturbed absorption of paracetamol was demonstrated, when compared to a control group, after general anesthesia without the administration of opiates. No investigations have been conducted regarding the time-specific correlation between the taking of OCs and general anesthesia. General anesthesia cannot significantly influence the distribution mechanism of estrogens and progesterones. It has been demonstrated that the clearance rate for gestagens in pregnant rats during general anesthesia is lowered, which probably can be attributed to a counter-regulation in response to a simultaneously diminished gestagen production. There are no data relating to the interaction of anesthetics and estrogen and gestagen receptors. It is likely that the coordinated increase of luteinizing and follicle-stimulating hormones through general anesthesia can be excluded. The disturbed absorption of OCs is considered to be the only significant factor whereby general anesthesia exerts an influence.
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PMID:[Anesthesia and "the pill"]. 945 98

The aim of this study was to test the feasibility of transesophageal ultrasonography in rats by using an intravascular ultrasound system for visualization of vegetations at the aortic valve in the animal model of experimental endocarditis. After anesthesia and preparation of the right carotid artery, a polyethylene catheter was advanced across the aortic valve into the left ventricle in 91 rats. For transesophageal ultrasonography an intravascular ultrasound catheter (3.5 French; 30 MHz) linked to an imaging system was introduced into the esophagus. Sonographic investigations were performed every 24 hours until death. The presence, size, and echogenicity of vegetations were evaluated. Presence and size were compared to autopsy findings. No complications occurred as a result of the sonographic investigation. Left-sided valvular structures were imaged regularly. For detection of vegetations, sensitivity and specificity were 93% and 88%, respectively. Comparing the measurements of the vegetation size the following regression equation was obtained: y = 0.74x + 0.04 (r = 0.89; standard error of estimate = 0.02 cm). Inter- and intraobserver variabilities for sonographic measurements were 8.3% and 6.2%, respectively. Transesophageal ultrasonography permits reliable detection and repetitive accurate quantification of vegetations in the rat model of endocarditis. The technique enhances longitudinal studies of the dynamic process of the growth of vegetations under defined microbial conditions.
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PMID:Transesophageal ultrasonographic imaging in rat hearts: visualization of aortic valve vegetations in non-bacterial thrombotic endocarditis. 951 59

The authors present the standards for postoperative care of patients with concomitant cardiovascular diseases used at Medical Center No. 122 in St. Petersburg. Special attention is paid to detailed assessment of cardiac function, continuity of the pre-, intra-, and postoperative cardio- and vasotropic therapy, and adequacy of anesthesiological protection as the main guarantee of an uneventful postoperative course. The authors consider it important that preoperative examinations include echocardiography and daily ECG monitoring; preoperative treatment is to include antibiotic prevention of infective endocarditis and heparin prevention of pulmonary artery embolism in the risk group patients. Alternative methods for intraoperative hemodynamic monitoring are pulmonary artery catheterization and integral rheography with the real-time data processing. The importance of regional anesthesia and the hazards of hypercorrection of the globular volume are emphasized.
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PMID:[Standards of examination, anesthesia and postoperative care of surgical patients with concomitant cardiovascular diseases]. 961 78


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