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

Thirty-three cases of infective endocarditis presenting during a 6.5 year period to a district general hospital were analysed retrospectively. The annual incidence was 22 cases per million population. Twenty-two cases had pre-existing cardiac disease, mainly valvular disease-usually rheumatic (nine cases) and prosthetic valves (10 cases). Recognizable precipitants such as recent surgery were uncommon. Two cases presented after deliberate drug overdose possibly due to depression exacerbated by systemic disease. Symptoms were usually non-specific. All but two cases had murmurs and most were pyrexial. Splinter haemorrhages and clubbing were seen in about 20% of cases. Viridans-type streptococci were the commonest infecting organisms (14 cases). Staphylococcal infection (six cases) was confined to intravenous drug abusers and patients with prosthetic valves. Five cases were culture negative. Cardiac failure was present in 13 cases at presentation and developed in seven others during treatment. Acute valve replacement was necessary in eight cases, and late replacement in three. Renal impairment (plasma urea > 8 mmol/l and/or plasma creatinine > 120 mumol/l) occurred in 19 cases during the course of their illness. Embolic phenomena occurred in 12 patients and mostly involved the central nervous system. In the 8 fatal cases, the cause of death was cardiac failure in six, cerebrovascular accident in one, and myocardial infarction in one. Four of the six patients who subsequently died of cardiac failure had been referred for surgery. Both those who were not referred had coexisting medical problems. Factors associated with increased mortality were age, male sex, cardiac failure (P < 0.01), renal impairment (P < 0.05), and embolic phenomena (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Infective endocarditis in a district general hospital. 143 86

Patients (n = 195) undergoing aortic valve replacement (n = 209) for native or prosthetic valve endocarditis were studied to determine risk factors for death and recurrent endocarditis and also to determine the valve type least likely to be associated with recurrent endocarditis. Ten-year survival was 60%, the highest risk of dying occurring within the first 3 postoperative months. Risk factors for death in this early phase included increased urea concentration, higher New York Heart Association functional class, prosthetic valve endocarditis, infection status (lower in patients with healed endocarditis), longer duration of cardiopulmonary bypass, and nonuse of an allograft valve. In the late phase (beyond 3 months), risk factors included age at operation and Staphylococcus aureus infection (only in New York Heart Association functional class V). Ten years after aortic valve replacement, 79% of valves were free of recurrent endocarditis. The highest risk of recurrence was in the first 4 months. Longer duration of cardiopulmonary bypass was a weak risk factor for recurrent endocarditis in the early phase, and in the late phase risk factors were S. aureus infection (only in New York Heart Association functional classes III, IV, and V) and the use of now discontinued biologic valves. Allograft aortic valve replacement was shown to be associated with a low and constant risk of recurrent endocarditis, whereas other valve types were associated with a high early risk. The allograft valve should be the preferred replacement device for aortic root infection.
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PMID:Aortic valve infection. Risk factors for death and recurrent endocarditis after aortic valve replacement. 149 18

A total of 1689 consecutive patients underwent isolated aortic valve replacement at the Cleveland Clinic Foundation from 1972 through 1986. There were 57 (3.4%) in-hospital deaths. Multivariate analysis identified advanced age (p = 0.0014), preoperative blood urea nitrogen level greater than 25 mg/100 ml (p = 0.008), New York Heart Association function class (p = 0.015), and preoperative atrial fibrillation (p = 0.04) as independent variables associated with increased in-hospital mortality and the use of cardioplegia for myocardial protection (p = 0.006) as a factor decreasing mortality. Follow-up documented survival rates of 85% and 66% and event-free survival rates of 71% and 43% at 5 and 10 postoperative years, respectively. Advanced age, moderate or severe impairment of left ventricular function, coronary artery disease, and preoperative blood urea nitrogen level greater than 25 mg/100 ml were associated with decreased late survival and event-free survival (all p less than 0.05). Patients with bioprostheses had better survival (p = 0.003) and event-free survival (p = 0.0007) rates than patients with mechanical valves. Patients with bioprostheses had superior results only if not receiving warfarin, and they experienced more reoperations and endocarditis; those with mechanical prostheses had more strokes, myocardial infarctions, bleeding complications, and thromboembolic events. Analysis of patients grouped according to age at operation showed that bioprostheses were associated with improved survival and event-free survival for patients 40 years older or older. Younger patients experienced more reoperations and episodes of endocarditis, and older patients more thromboembolic complications. We conclude that 10-year results after isolated aortic valve replacement are influenced by both patient-related and management-related variables, and the impact of these factors is different for patients of different ages.
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PMID:Primary isolated aortic valve replacement. Early and late results. 270 60

Eighteen patients with documented Gram-positive infections which included osteomyelitis, prosthetic infections, endocarditis, skin and soft tissue, and urinary tract infections were treated with teicoplanin. The organisms involved included Staphylococcus aureus (15 isolates of which six were methicillin-resistant-MRSA), Staphylococcus epidermidis (two), Streptococcus faecalis (one) and Streptococcus milleri (one). Clinical success occurred in all seven patients with skin and soft tissue Streptococcus milleri (one). Clinical success occurred in all seven patients with skin and soft tissue infections (with bacterial persistence in three out of the seven), in three patients with bacteraemia endocarditis, and in one of the three patients with chronic osteomyelitis. In four patients with prosthetic bone and joint infections, clinical improvement followed removal of prostheses. Adverse effects occurred in two patients and these included one patient with a rise in serum aspartate aminotransferase and bilirubin and one patient with a rise in blood urea, both of which returned to within normal limits on discontinuing the drug. The study showed that teicoplanin is a safe and effective antistaphylococcal agent.
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PMID:Open study of teicoplanin in gram-positive infections. 296 1

Endocarditis due to Haemophilus is uncommon. This is the first reported case caused by Haemophilus aegyptius. The course of the disease was complicated by pericarditis, congestive heart failure, and myocardial abscess formation. Surgical removal of the damaged aortic valve was not beneficial. The biologic properties of the organism included urea degradation, absence of indole metabolism, and absence of the enzyme ornithine decarboxylase.
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PMID:Endocarditis caused by Haemophilus aegyptius. 372 58

Of 2030 consecutive patients with bacteremia, only 102 were free from underlying disorders. 43 were males, and the median age was 66 years. The sources of infection were the urinary tract (in 48%), lower respiratory tract (13%), endocarditis (7%), biliary tract (6%) and the meninges (5%). The most common pathogens were Escherichia coli (in 45% of patients), Streptococcus pneumoniae (21%), Staphylococcus aureus (9%) and hemolytic streptococci (9%). Overall mortality rate was 13%, 4% in patients with urinary tract infection and 19% in patients with other sources. Half of the deaths occurred within 2 days of hospitalization, and 75% of them within 4 days. All patients with septic shock and all patients with meningitis died. Other factors related to mortality were residence in a nursing home, low functional capacity, advanced age, high blood urea nitrogen and creatinine and low albumin, and infections caused by Staphylococcus aureus, Neisseria meningitidis and polymicrobial infections. A protective effect of appropriate antimicrobial antibiotic therapy could not be demonstrated. In conclusion, bacteremic patients with no known underlying disorder and source of their infection other than the urinary tract should be given maximum supportive treatment and should be closely watched.
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PMID:Bacteremia in patients without known underlying disorders. 785 58

A retrospective study was conducted on 124 patients who underwent re-replacement of previously implanted prosthetic heart valves for structural valve failure, prosthetic valve endocarditis, periprosthetic leak, a thrombosed valve, hemolysis, or prophylactic removal. In total, 85% of the explanted valves were bioprostheses, and 70% of the newly implanted valves were mechanical valves. The overall operative mortality rate was 8.1%, being 3.2% of 95 single valve recipients and 25.0% of 28 double valve recipients (P < 0.001). The overall mortality rate dropped from 13.6% of 66 patients before 1988, to 1.7% of 58 patients encountered in the last 3 years (P < 0.02). Since 1988, a third of the patients have undergone reoperation without homologous blood transfusion. A univariate analysis revealed eight operative risk factors, namely: higher values of preoperative blood urea nitrogen or total bilirubin, double valve replacement at the redo operation, NYHA class IV, urgency of reoperation, a duration of implantation of less than 3 months, reoperation in the earlier period of this study, and reexploration for bleeding or cardiac tamponade after re-replacement surgery. A multivariate statistical analysis demonstrated that preoperative blood urea nitrogen, urgency of reoperation, double valve replacement, and the duration of implantation were independent risk factors. Thus, we recommend that surgery be performed early, before the occurrence of other organ failure induced by congestive heart failure due to any form of valve dysfunction.
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PMID:The risks of reoperation for prosthetic valve dysfunction. 805 12

From September, 1978, through January, 1993, 67 patients (mean age: 44 years) underwent surgical treatment for infective endocarditis (IE) at Kagoshima University. Of 67 patients, 36 showed active endocarditis and 31 healed endocarditis at the time of operation. The over-all hospital mortality was 22.4% (15/67). Risk factors associated with operative mortality by univariate analysis included increased blood urea concentration (BUN), increased cardiothoratic ratio, higher New York Heart Association functional class, infection status (active/healed), aortic valve infection, prolonged aortic cross-clamp time, annular abscess, and calendar year. The patients were operated earlier in the latter part of this series (1988-1993. Multiple logistic regression analysis demonstrated three factors to be statistically significant: BUN, operative year, and aortic valve infection. Complete survival information was obtained in all 52 discharged patients with a mean follow-up time of 4.8 years. There were 5 late deaths including 3 patients with valve related complication. The actuarial survival rate at 10 years after operation excluding hospital mortality was 89%, 92% for active infection 88% for healed infection. The actuarial freedom from valve related complication was 86% at 10 years. The degree of activity of the infection is not a risk factor for operative mortality by multiple logistic regression analysis. We conclude that surgical intervention should be undertaken without delay in the patients with IE before development of hemodynamic deterioration causing renal dysfunction and hypercatabolism.
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PMID:[Surgical treatment of infective endocarditis--an analysis of the risk factors for operative mortality and long-term follow-up]. 817 91

Infective endocarditis caused by Kingella denitrificans occurs rarely. A review of the literature reveals only 6 cases of endocarditis caused by the bacillus. K. denitrificans is normally a commensal of the upper respiratory airways, may exceptionally be responsible for endocarditis. A case of possible prosthetic endocarditis caused by K. denitrificans is presented. A 78-year-old male with Type II diabetes was admitted to the hospital complaining of fever, a sore throat and arthralgia. He underwent replacement surgery of a St. Jude medical prosthesis for aortic stenosis at the age of 75. The only physical findings at admission were a temperature of 38.2 degrees C and murmurs of mild mitral regurgitation. The liver and spleen were not palpable, and there were no skin or eye lesions. Laboratory findings were as follows: white blood cell count 9500/microliters with 77% neutrophils, erythrocyte sedimentation rate 71 mm/h (Westergren), blood urea nitrogen 50.2 mg/dl, serum creatinine 1.7 mg/dl and C-reactive protein 22.2 mg/dl. The Gram-negative bacillus isolated from the blood was identified as K. denitrificans by the identification system, namely ID test.FN-20 rapid (Nissui, Japan). Although an echocardiogram detected no vegetation, infective endocarditis was diagnosed because the same bacillus was detected by separate blood cultures and an obvious source of infection was not found other than the prosthetic valve. Initial treatment was flomoxef, which was changed to Ampicillin 2 g/day after K. denitrificans was identified. Ampicillin continued for 6 weeks. The clinical course was good and he did not require further surgery. He has been afebrile for 2 years after completing treatment. This case represents the first report of prosthetic valve endocarditis caused by K. denitrificans in Japan.
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PMID:[Prosthetic endocarditis caused by Kingella denitrificans in a patient with diabetes mellitus]. 928 46

The use of ventricular assist devices as a bridge to transplantation has become a widely used option for patients with end-stage heart failure. In contrast to total artificial hearts, ventricular assist devices support the failing heart by bypassing one or both ventricles. In certain cases (myocardial tumors, graft failure, transplant rejection, endocarditis, intracardiac thrombus formation), however, it may be advantageous to excise the heart and replace it with an artificial device. Total artificial hearts are intracorporeal devices designed for this purpose. Unfortunately, some patients are too small or are, for other reasons, ineligible for a total artificial heart. We describe the case of a 55-year-old woman who had ischemic cardiomyopathy and thrombus formation in all 4 cardiac chambers. To reduce the risk of thromboembolic events, we elected to replace her heart completely with 2 extracorporeal ventricular assist devices. The heart was excised via a median stemotomy approach, and the outflow cannulae (from device to patient) were connected to both atrial remnants. The 2 inflow cannulae (from patient to device) were anastomosed end-to-end to the aorta and the pulmonary artery, respectively. After attaining a flow of more than 5 L, the 2 extracorporeal assist devices effectively and efficiently performed the work of the native heart. Thus re-established, organ perfusion was improved by this mechanically driven circulation, as signified by an initial decrease in creatinine and blood urea nitrogen levels. The patient, however, did not recover from postoperative neurological dysfunction and died of respiratory insufficiency and multiple-organ failure on the 26th postoperative day.
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PMID:End-stage heart failure with multiple intracardiac thrombi: a rescue strategy. 1574 93


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