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

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

One hundred and fifty-five patients with isolated mitral regurgitation were referred from our Department of Cardiology for mitral valve repair between 1972 and 1990. Men were in the majority (59%), the mean age was 51 years and 61% of the patients were in NYHA class III or IV. Degenerative or dystrophic etiologies predominated, followed by rheumatic origins (17%) and bacterial endocarditis (14%). Surgical repair was performed using Carpentier's techniques: insertion of a prosthetic ring (87%) valvular resection (73%), valvular mobilization (11%), closure of a perforation (4,5%) and resection of vegetations (4,5%). Two patients died during surgery and 7 were lost to follow-up; the others were followed for an average of 4 years, i.e., a cumulative follow-up of 584 years/patients. The overall results at 11.5 years were satisfactory: 84.5% survival rate and 64.5% with good valvular function. The linearized rates of endocarditis, thromboemboli, hemorrhagic complications (51 patients were taking anticoagulants) and repeated interventions were, respectively: 0.35, 1.54, 0.17 and 2.05%/patient-year. Residual mitral regurgitation was sought by clinical and Doppler examinations: 55.5% of the patients had none, 26% had mild, 10.3% had moderate and 8.2% had severe regurgitation. Analysis of the latter two groups identified 3 influencing factors: rheumatic origin of the regurgitation, surgery on the anterior cusp and the year surgery was performed (the post-surgical incidence has decreased in recent years). Other, less-well-known complications were also found: left ventricular outflow tract obstruction, progressive evolution towards mitral stenosis, development of aortic regurgitation (usually discreet) and formation of left atrial thrombi.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term results of surgical valvuloplasty for non-ischemic mitral insufficiency. Apropos of 155 cases]. 180 76

One hundred and fifty-five patients with isolated mitral regurgitation were referred from our cardiology department for mitral valve repair between 1972 and 1990. Men were predominant (59%), mean age was 51 years, and 61% of the patients were in NYHA class III or IV. Degenerative aetiology was predominant (65%). Surgical repair was performed according to the Carpentier techniques. Two operative deaths occurred (1.3%). The survivors were followed-up for an average of 4 years, and the rates of survival and good functional results at 11.5 years, were respectively 84.5% and 64.5%. The linearized rates of endocarditis, thromboembolic events and re-operations were respectively 0.35%, 1.54% and 2.05% pt-yrs. Residual mitral regurgitation was looked for by clinical and Doppler examination: there was no regurgitation in 55.5% of patients, mild regurgitation was found in 26%, moderate in 10.3% and severe in 8.2%. Analysis of moderate and severe residual regurgitation identified three promoting factors: rheumatic origin of the regurgitation, surgery of the anterior leaflet and time of surgery (the incidence after surgery has been lower in recent years). Other 'less well known' complications were encountered: left ventricular outflow tract obstruction, progressive evolution towards mitral stenosis, appearance of aortic regurgitation and formation of left atrial thrombi. Despite these complications, we must stress the satisfactory results of the technique, in particular in mitral valve endocarditis; 22 patients were operated on for this reason, six during the acute phase of the disease, and no surgical death, or recurrence of endocarditis, and only one case of severe residual regurgitation was observed.
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PMID:Long-term results of mitral valve repair for non-ischaemic mitral regurgitation. 193 22

Cases of infective endocarditis superimposed upon prolapsing mitral valves were first described two decades ago. In the intervening years 72 reports in the English-language literature have described 267 such cases. Men predominated numerically in cases occurring after the age of 40 years and in surgical and autopsy series. In cases with auscultatory abnormalities documented before the onset of infective endocarditis, murmurs-and not merely isolated systolic clicks--were usually present. Complications of infective endocarditis were relatively common, and at least 42 patients required valve replacement in the acute phase of illness or during convalescence. Although viridans streptococci were the most frequent etiologic agents (46% of cases), deaths occurred primarily among patients infected with other organisms and among those over 40 years of age. Mitral valve prolapse is increasingly being recognized as a precursor of infective endocarditis because of its high prevalence in the general population and the wider availability of echocardiographic diagnostic techniques. The risk/benefit and cost/benefit ratios for endocarditis prophylaxis in patients with prolapsing mitral valves remain controversial.
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PMID:Infective endocarditis complicating mitral valve prolapse: epidemiologic, clinical, and microbiologic aspects. 351 83

The most common causes of infective endocarditis, accounting for 65 to 85% of all cases, are viridans streptococci and other nonhemolytic streptococci. Enterococci are the offending microorganisms in 5 to 15%, staphylococci in 5 to 15% and gram-negative bacteria from the intestinal tract in 2 to 6%. In rare cases, infective endocarditis may be caused by any of a number of other pathogenic and nonpathogenic bacteria. Men over 60 years of age and women under 40 have a higher likelihood of contracting enterococcal endocarditis subsequent to febrile infections of the urogenital tract or after abortion; intravenous drug users tend to infections with gram-negative bacteria; patients with intravascular catheters who are administered cortisone, broad-spectrum antibiotics or cytostatic drugs are at risk of endocarditis from Candida or Aspergillus. At least two, but in general, five blood cultures should be drawn in short intervals. With the use of proper techniques for detection of aerobic and anaerobic microorganisms as well as fungi, positive blood cultures can be obtained in 95% of the patients. Antibiotics may be discontinued temporarily in pretreated patients. Bactericidal antibiotics are indicated. The following rule is valid as a guideline for adequate antibacterial chemotherapy: at maximal concentration after antibiotic administration, a bactericidal effect should still be demonstrated after 1:8 dilution of the patient's serum. Prior to receipt of blood culture findings, in forms tending to be subacute, treatment should be directed at streptococci and enterococci. If the course is more acute, in the presence of an intracardiac foreign body or in intravenous drug users, the antibiotic employed should also be effective against staphylococci.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Antibiotic therapy in infectious endocarditis]. 666 77

Between June 1980 and September 1981 we evaluated 24 cases of endocarditis from methicillin-resistant Staphylococcus aureus. All of the cases occurred in drug addicts and all were community-acquired. The patients ranged in age from 21 to 59 years and represented an older population than that generally reported for bacterial endocarditis in addicts. Men and women were equally represented (one man presented twice). This unusually high proportion of women may reflect a difference in the rate and location of carriage of methicillin-resistant S. aureus compared with that of methicillin-sensitive staphylococci. Three patients died, one of whom had signed out of the hospital on the 14th day and returned moribund 27 days later. Vancomycin treatment for 28 days was adequate therapy for most patients.
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PMID:Community-acquired methicillin-resistant Staphylococcus aureus endocarditis in the Detroit Medical Center. 711 30

Fungal endocarditis has become an important infection associated with medical progress and a modern lifestyle. The most common organisms isolated from patients with fungal endocarditis are: Aspergillus spp.; Candida spp. and Torulopsis glabrata. Men are more frequently affected than women and predisposing factors include: previous cardiac surgery, antibiotic use and hyperalimentation, long-term i.v. catheters. Common clinical findings in patients with endocarditis include: fever, changing murmurs, peripheral emboli which are characteristically large and chorioretinitis. Characteristic laboratory findings are absent and positive blood cultures are obtained only in a relatively small number of patients. Characteristically, Aspergillus spp. almost never grow in blood cultures and must be isolated from removed emboli, from the diseased valve or from infected foreign bodies. Overall survival in patients with fungal endocarditis is rather poor, and hardly exceeds 50%. In general, a combined surgical-medical approach would yield the best results. New therapeutic modalities are needed in order to improve the prognosis of fungal endocarditis.
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PMID:Fungal endocarditis. 767 32

The pharmacokinetics of gentamicin in adult patients with endocarditis were studied. The records were reviewed for 64 patients treated for bacterial endocarditis and for whom serum gentamicin concentrations had been requested between May 1990 and May 1993. The patients were divided into those with serum creatinine concentration (SCr) <1.2 mg/dL and those with SCr > or = 1.2 mg/dL. The measured serum gentamicin concentrations, patient demographic information, dosage interval, and SCr were entered into a pharmacokinetics program for analysis. The pharmacokinetic values evaluated were steady-state distribution volume (V), clearance (CL), elimination rate constant (k), and half-life (t1/2). The mean +/- S.D. t1/2 and V of gentamicin were 4.7 +/- 2.4 hr and 0.29 +/- 0.11 L/kg. Half-life was correlated with SCr and V. These two variables may explain 66% of the variation in t1/2. No difference in V was observed between patients with normal versus abnormal SCr. Men had a lower k than women. V and CL were lower in patients under age 60 than in older patients. Adult patients with endocarditis may have expanded gentamicin V. V and CL accounted for most of the variation in gentamicin t1/2.
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PMID:Gentamicin pharmacokinetics in adults with bacterial endocarditis. 794 77

Elderly dental patients are at risk of developing infective endocarditis. Increased longevity is associated with an increased prevalence of cardiac valvular disease and impairment of the immune system. Aortic stenosis commonly occurs in persons between 60 and 75 years of age. Degenerative calcification of the mitral valve ring leading to valve incompetency often develops in those over age 70 years. Men over the age of 60 years with mitral valve prolapse and systolic hypertension are at risk of infective endocarditis because the excessive haemodynamic load placed upon the abnormal valve causes extensive stretching of cusps and loss of valve surface endothelium. Dental procedures, that result in mucosal or gingival bleeding (most notably dental extractions, periodontal probing, scaling and surgery, endodontics and restorative procedures which extend below the gingival line), frequently produce a bacteraemia. Anaerobic strains of bacteria are isolated twice as frequently as aerobic strains. Antibiotic prophylaxis decreases the level of bacteraemia, prevents adherence of bacteria to the damaged valvular epithelium and suppresses the growth of those microbes that manage to adhere to the valve. The standard prophylactic regimen consists of amoxicillin 3g 1 hour before the dental procedure, then 1.5g 6 hours after the initial dose. Erythromycin is a good alternative for penicillin-allergic patients. Topical chlorhexidine 5 minutes before initiating dental therapy reduces the bacterial inoculum and the likelihood of endocarditis.
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PMID:Pathogenesis and prevention of native valve infective endocarditis in elderly dental patients. 801 55

The Ross procedure has shown superior hemodynamic results in young patients with aortic root pathology. Wider application of the procedure is restricted by its technical complexity and potential associated problems. The mortality/morbidity associated with 130 consecutive patients who have had the Ross procedure using the root replacement implantation technique between October 29, 1990, and October 8, 1998 is summarized. New York Heart Association (NYHA) preoperatively was class I, 23.5%; class II, 64.7%; and class III, 11.8%; mean age was 36 years (range 3 to 67 years). Men accounted for 73.8% and women 26.2% of the series. Preoperative diagnosis was congenital, 80.7%; rheumatic, 5.3%; failed prosthesis, 7.0%; degenerative, 2.6%; and endocarditis, 4.4% with preoperative aortic insufficiency (AI) 7.9% 1+, 19.8% 2+, 29.7% 3+, and 42.6% 4+, respectively. At operation mean cross-clamp time was 201 minutes (range 102 to 280 minutes). Patient follow-up was 99.2% (1 patient lost to follow-up), and 94.4% were NYHA class I at follow-up and 5.6% class II. Postoperative AI was 0 to 1 + in 93.6% and 2+ or greater in 6.4%. Mean time to patient follow-up was 436 days (range, 20 days to 2,878 days). Thirty-day mortality rate was 1.5%; one patient died of mediastinal bleeding, and one from complications of acute pancreatitis. There was no late mortality. Early autograft explant occurred in one patient secondary to iatrogenic injury to the pulmonary autograft at the time of harvesting, and one late explant occurred secondary to proximal suture line dehiscence. Late autograft repair occurred in one patient secondary to a false aneurysm along the proximal suture line; one patient was reoperated for left main coronary stenosis relative to iatrogenic injury at the time of the procedure. Right ventricular outflow tract replacement has occurred in two patients. Postoperative morbidity and mortality for the Ross procedure, as shown in this series, remains low and supports broader application of the procedure.
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PMID:Critical analysis of the Ross procedure: do its problems justify wider application? 1066 Jan 67


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