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

Abnormal embryologic development and inflammatory or degenerative diseases cause valvular heart disease in children. Physicians consider children's age, size, pathology and natural history of the disease, size and anatomy of cardiac chambers and great vessels, and success of past interventions when deciding on valve replacement. The 1st treatment tends to be preservation and reconstruction of the natural valve. It is difficult to obtain a prosthetic valve of adequate size. Because the child is growing quickly the prosthetic valve, quickly becomes too small an hemodynamically restrictive. A prosthetic valve increases the risk of infection. The 3 main types of prosthetic valves are bioprosthetic, mechanical, and allograft valves. Management issues of a child undergoing heart valve replacement surgery include thromboembolism, minimalizing blood coagulation without undue bleeding, endocarditis, and pregnancy. More and more females with prosthetic heart valves are achieving reproductive years. Women with adequately efficient valves and are in the American Heart Association class I or II face a much better likelihood of a successful pregnancy and fetal outcome than those in class III or IV. Indeed women of class III or IV regardless of the conditions of the valve should not become pregnant until their status has been upgraded. Pregnancy risks include ability of the heart to maintain cardiac output and stroke volume and teratogenic effects of sodium warfarin on the fetus. Pregnant patients can receive subcutaneous heparin therapy, however. Nurses can play a leading role in counseling parents of heart valve replacement children. For example, they can educate them and their affected children about contraception while they are in their early teens. Specifically they need to counsel them about the risks of pregnancy and of using estrogen-based contraceptives and IUDs. Diaphragms and condoms along with a spermicide are the best methods for heart valve replacement females.
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PMID:An overview of artificial heart valve replacement in infants and children. 155 84

The Edwards pericardial aortic valve has unique design features that minimize cusp stress and reduce abrasion wear. Wear tests and in vivo fluid dynamic tests have shown superior performance compared with other bioprostheses. Between August 1981 and July 1985, 719 isolated aortic valves were implanted in 10 US centers. Patients were aged 18 to 90 years (mean, 64 years). Men were 63.3% of the patients. Aortic stenosis was present preoperatively in 63.4% of patients. New York Heart Association functional classes III and IV were assigned to 62% of the patients. Valve sizes were 21 mm or less in 49% of patients. Concomitant procedures (most often coronary artery bypass grafting) were performed in 48% of patients. Hospital mortality was 4.7%. There was one valve-related death due to anticoagulant hemorrhage. Late mortality yielded 23 valve-related deaths: endocarditis (13), anticoagulant hemorrhage (4), thromboembolism (3), structural (2), and pannus overgrowth (1). Freedom from valve-related death at 7 years was 95.5%. Regarding valve survival, cusp tears were not seen. There were 11 calcified valves and eight explants (57 to 107 months). Seven-year freedom from all valve reoperation was 95.5%, with 11% of the patients receiving warfarin sodium, freedom of the total series from hemorrhage at 7 years was 93.3%, and from major thromboembolism, 95.8%. Echocardiographic follow-up of hemodynamics at 7 years yielded the following calculated effective orifice areas: 19 mm, 1 cm2; 21 mm, 1.3 cm2; and 23 mm, 1.4 cm2. Average mean gradient for 19-mm valves was 15 mm Hg. New York Heart Association class improved in 78% of the patients. The Carpentier-Edwards pericardial valve, carefully studied by the Food and Drug Administration guidelines, is easy to use and has excellent hemodynamics.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The Carpentier-Edwards pericardial aortic valve: intermediate results. 157 Sep 67

Isolated aortic (n = 857) or mitral (n = 793) valve replacement with a porcine bioprosthesis was performed in 1650 patients between 1971 and 1980. Follow-up (total = 12,012 patient-years) extended to more than 15 years and was 96% complete. Patient age ranged from 16 to 87 years; mean age was 59 +/- 11 years (+/- 1 standard deviation) for the aortic valve replacement cohort and 56 +/- 12 years for the mitral valve replacement cohort. The operative mortality rates were 5% +/- 1% (+/- 70% confidence limits) and 8% +/- 1%, respectively, for the aortic and mitral subgroups. Estimated freedom from structural valve deterioration (+/- 1 standard error of the mean) after 10 and 15 years was significantly higher for the aortic than for the mitral valve replacement subgroup (85% +/- 0.4% and 63% +/- 3% versus 78% +/- 2% and 45% +/- 3%, respectively, p = 0.001). Reoperation-free actuarial estimates were also significantly greater for the aortic valve replacement cohort: 83% +/- 2% and 57% +/- 3% versus 78% +/- 2% and 43% +/- 3% for mitral valve replacement at 10 and 15 years, respectively. The mortality rate for reoperative aortic valve replacement was 11% +/- 1%; it was 8% +/- 1% for reoperative mitral valve replacement. Importantly, the estimates of freedom from valve-related death (including sudden, unexplained deaths) were relatively high at 10 and 15 years: 78% +/- 2% and 69% +/- 3% in the aortic cohort and 74% +/- 2% and 63% +/- 3% in the mitral cohort (p = not significant). Excluding sudden, unexplained deaths, these estimates were 81% +/- 3% (aortic) and 73% +/- 4% (mitral) at 15 years. Thromboembolism-free rates were 84% +/- 3% (aortic) and 78% +/- 6% (mitral) at 15 years, and freedom from anticoagulant-related hemorrhage was 96% +/- 1% and 89% +/- 2%, respectively. At the time of current follow-up, 13% of patients having aortic valve replacement and 50% of patients having mitral valve replacement were receiving warfarin sodium. The hazard functions for thromboembolism and prosthetic valve endocarditis were constant and remained less than 1%/pt-yr over the entire follow-up period.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Durability of porcine valves at fifteen years in a representative North American patient population. 173 89

Group G streptococci which have been isolated from the oral flora of rats are also normal inhabitants of the human skin, oropharynx, gastrointestinal tract, and female genital tract. This group of streptococci can cause a wide variety of clinical diseases in humans, including septicemia, pharyngitis, endocarditis, pneumonia, and meningitis. Ten days after oral gavage with 7,12-dimethylbenz[a]anthracene, 12 of 22 two-month-old, female, outbred, viral-antibody-free rats presented with red ocular and nasal discharges and marked swelling of the cervical region. Various degrees of firm, nonpitting edema in the region of the cervical lymph nodes and salivary glands as well as pale mucous membranes and dehydration were observed. Pure cultures of beta-hemolytic streptococci were obtained from the cervical lymph nodes of three rats that were necropsied. A rapid latex test system identified the isolates to have group G-specific antigen. These streptococcal isolates fermented trehalose and lactose but not sorbitol and inulin and did not hydrolize sodium hippurate or bile esculin. A Voges-Proskauer test was negative for all six isolates. Serologic tests to detect the presence of immunoglobulin G antibody to rat viral pathogens and Mycoplasma pulmonis were negative. Histopathologic changes included acute necrotizing inflammation of the cervical lymph nodes with multiple large colonies of coccoid bacteria at the perimeter of the necrotiz zone. To our knowledge, this is the first report of naturally occurring disease attributed to group G streptococci in rats.
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PMID:Group G streptococcal lymphadenitis in rats. 175 39

Fifty-two patients with moderate or severe infections associated with internal medicine were treated with imipenem/cilastatin sodium (IPM/CS) and the efficacy and the safety of this drug were evaluated. There were 20 patients with pneumonia, 10 with acute exacerbation of chronic respiratory tract infections, 9 with sepsis, 2 with pyothorax, 3 with intraabdominal infection, 2 with urinary tract infection, 1 with pulmonary abscess, 1 with infective endocarditis, 4 with fever of unknown origin. Forty-four patients were evaluable for the efficacy. Clinical efficacies were excellent in 12 patients, good in 26, fair in 3 and poor in 3. The overall clinical efficacy was 86.4%. The efficacy rate was 63.6% in patients previously treated and 93.9% in patients previously untreated with other antibiotics. Bacteriologically, Staphylococcus aureus (8 strains), Streptococcus pneumoniae (5), Streptococcus pyogenes (1), other Gram-positive coccus (1), Klebsiella pneumoniae (8), Haemophilus influenzae (4), Pseudomonas aeruginosa (3), Serratia marcescens (3), Escherichia coli (3), Branhamella catarrhalis (1), Citrobacter freundii (1), Klebsiella oxytoca (1), Enterobacter sp. (1), and Peptostreptococcus sp. (1) were eradicated. P. aeruginosa (3) and Acinetobacter sp. (1) decreased. S. aureus (1), S. epidermidis (1), P. aeruginosa (5), and S. marcescens (1) persisted or appeared. The eradication rate was 83.7%. Six patients showed adverse reactions including general fatigue 1, epigastralgia 1, eruption 1, eosinophilia 1 and elevation of S-GOT 2. But all of the adverse reactions were mild or slight, and transient. These findings indicate that IPM/CS is a useful and safe drug against bacterial infections in internal medicine.
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PMID:[Clinical evaluation of imipenem/cilastatin sodium in the internal medicine]. 192 Aug 13

A case of infective endocarditis due to Streptococcus agalactiae was treated conservatively by means of cefotaxime sodium given intravenously at a dose of 1 g every six hours supplemented with gentamycin sulphate, also given intravenously, with the dose adjusted according to concentrations of the drug in the plasma. The treatment was successful.
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PMID:Endocarditis due to Streptococcus agalactiae: a favorable outcome with conservative treatment. 220 93

Infective endocarditis caused by Staphylococcus aureus may be initiated by bacterial binding to cardiac valve cells. We investigated binding of whole S. aureus organisms to preparations of isolated porcine cardiac valve proteins. Cultured endothelial and subendothelial cells were surface labeled with iodine 125. After preabsorption with Escherichia coli, an organism that only rarely causes infective endocarditis, binding of surface proteins to S. aureus was assessed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and subsequent autoradiography. The results showed that cardiac valve endothelial cells expressed a major S. aureus-binding protein with an approximate apparent molecular weight of 120,000. In contrast, cardiac valve subendothelial cells expressed on their surface a single species of binding protein with an approximate apparent molecular weight of 220,000; immunoblot analysis suggested that this protein was fibronectin. We also used radiolabeled S. aureus to probe cellular proteins transferred to nitrocellulose membranes. This technique identified a 125,000 molecular weight protein that bound S. aureus in endothelial cell extracts. We conclude that specific S. aureus binding to cardiac valve cells is mediated by different receptors for endothelial and subendothelial cells.
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PMID:Identification of Staphylococcus aureus binding proteins on isolated porcine cardiac valve cells. 229 65

A case of community-acquired endocarditis caused by Enterococcus (Streptococcus) faecalis with high-level resistance to gentamicin sulfate but not to streptomycin sulfate is described. Killing curves performed using achievable serum levels showed synergistic killing when streptomycin but not gentamicin, tobramycin, or amikacin was combined with penicillin G sodium or vancomycin hydrochloride. Combination therapy with vancomycin and streptomycin resulted in cure. Serum bactericidal levels indicated activity of the synergistic, as well as a nonsynergistic (vancomycin plus gentamicin), combination. Routine screening of blood isolates for high-level resistance to streptomycin and gentamicin can provide guidance for selection of therapeutic combinations in serious enterococcal infections, including endocarditis.
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PMID:Endocarditis due to streptomycin-susceptible Enterococcus faecalis with high-level gentamicin resistance. 250 23

The antigenic composition of an endocarditis-associated isolate of Streptococcus faecalis was studied by immunoblotting of whole cells and cell walls from sodium-dodecyl sulphate polyacrylamide gels on to nitrocellulose and detection with serum from patients and hyperimmune rabbit serum. A major envelope protein antigen of mol. wt 53 X 10(3) detected with patient's serum was also present in three urinary strains of Str. faecalis and a laboratory strain of Str. faecalis ss. zymogenes but not in Staphylococcus aureus. Other common antigens of Str. faecalis were of mol. wt (10(3)) 65, 63, 56, 49.5, 30 and 21. Two other protein antigens (43 and 37 X 10(3) mol. wt) reacted strongly with asparagus pea lectin-peroxidase conjugate indicating the presence of fucosyl residues. Other lectin-peroxidase conjugates were used to demonstrate the presence of various glycosyl residues on envelope proteins. Growth of Str. faecalis in serum to mimic in-vivo growth conditions in endocarditis infections dramatically altered the antigenic patterns. Only two major antigens of mol. wt (10(3)) 56 and 53 reacted with sera from endocarditis patients. These antigens may, therefore, be of diagnostic or protective potential.
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PMID:Antigenic composition of an endocarditis-associated isolate of Streptococcus faecalis and identification of its glycoprotein antigens by ligand blotting with lectins. 308 28

We describe a method for the serodiagnosis of Streptococcus faecalis in infective endocarditis which could be of value in culture-negative cases. Serum-grown cells of S. faecalis produced three major characteristic protein antigens (73,000, 40,000, and 37,000 molecular weight) which were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of solubilized whole cells. After electrophoretic transfer to a nitrocellulose membrane, these antigens were visualized by probing with serum from patients with endocarditis caused by S. faecalis. Serum from patients with endocarditis caused by other organisms did not react with the S. faecalis-specific antigens. This procedure should facilitate positive early diagnosis of S. faecalis endocarditis or establish its absence in culture-negative cases.
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PMID:Serodiagnosis of Streptococcus faecalis endocarditis by immunoblotting of surface protein antigens. 310 51


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