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

In addition to a working knowledge of general complications such as thromboembolism and infective endocarditis, optimal care of the patient with a prosthetic valve requires specific knowledge concerning the characteristics of a given patient's prosthesis. This may need to include the ability to identify the valve roentgenographically when history and records are unavailable. A 53-year-old woman with mitral stenosis secondary to rheumatic heart disease and status post a reported Bjork-Shiley mitral valve (MV) replacement 17 years prior to hospital admission was referred for evaluation of severe hemolytic anemia. Previous cinefluoroscopy in 1986 at the time of a cerebrovascular accident revealed a normally functioning caged disc prosthesis and not the tilting disc of a Bjork-Shiley prosthetic valve. The valve was not further characterized and she continued receiving warfarin therapy until May 1989 when she presented with laboratory findings showing a marked hemolytic anemia with a hemoglobin of 6.5 mg/dl and lactate dehydrogenase (LDH) value of 2100 IU. Echocardiography revealed normal valvular function without evidence of perivalvular leak. The patient was referred for further evaluation with chest roentgenogram at the time of hospital admission revealing a valve configuration characteristic of the Beall model 103/104 series that has been found to manifest progressive disc variance with a high degree of hemolytic anemia (despite normal noninvasive evaluation of MV function), disc tilting with intermittent regurgitation, and catastrophic disc embolization in extreme cases. The precise identification of valvular prosthesis in patients after valve replacement is crucial for optimal management. As in our case, the mere identification of a particular valve may necessitate certain management and therapy based on the natural history of that valve. In the absence of reliable history and/or records, the roentgenographic examination should lead to the precise identification.
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PMID:Progressive hemolytic anemia due to delayed recognition of a Beall mitral valve prosthesis. 198 16

Between January 1, 1975, and December 31, 1988, 233 patients were operated on for correction of tetralogy of Fallot (TOF). Mean follow-up was 13.9 years (median 7.65 years) and was 99.6% complete. Actuarial survival was 84 +/- 3%. The risk of death decreased gradually to a constant rate of 0.00034 deaths/month by the 6th postoperative month. There were 22 early deaths, due mostly to Low Output Syndrome. The principal incremental risk factor was the postrepair ventricular pressure ratio (PRV/LV) (P less than 0.0001). Other factors were: patent ductus arteriosus (PDA; P = 0.02), other associated anomalies (P = 0.005), higher preoperative hemoglobin levels (P = 0.06) and use of transannular patches (P = 0.02). The operative risk was significantly reduced by a recent operative date (P = 0.01) and by an older age at operation (P = 0.12). Among 8 late deaths, 2 were unrelated to the cardiac condition, 2 occurred suddenly, 3 were due to congestive heart failure and the last was due to reoperation for patch endocarditis. The risk of late death was significantly higher in patients operated on at an older age (P = 0.04). There were 10 open heart reoperations: 5 for patch dehiscence, 4 for residual pulmonary stenosis and 1 for residual atrial septal defect. The reoperation-free actuarial survival was 82 +/- 3%. With the present operative standards, the parametric operative risk of an average patient with simple TOF (hemoglobin = 12 g, PRV/LV = 0.5) is 0.7%. Where the TOF is severely cyanotic (hemoglobin = 25 g) and the pulmonary arteries are severely restricted, the average mortality is 30%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Early and late results after repair of tetralogy of Fallot. 239 29

A 44-year-old man died suddenly, shortly after admission to the hospital with complaints of abdominal pain. Medical history was significant for chronic alcoholism and homozygous hemoglobin C disease. Autopsy revealed vegetations on the aortic valve, especially on the left coronary cusp. There was anomalous origin of the coronary arteries from the left sinus of Valsalva. The large vegetation on the left coronary cusp had extended into the left main-stem coronary artery and obstructed it. There was evidence of prior embolization to the right coronary artery with mycotic aneurysm formation and myocardial infarction. Other lesions included a cerebral artery mycotic aneurysm and metastatic abscesses within the myocardium and spleen. Although the aortic valve was free of underlying chronic pathology, the causative organism was Streptococcus viridans. This case illustrates several unusual, and, in some instances, unique findings in infective endocarditis.
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PMID:Sudden death due to left coronary artery occlusion in infective endocarditis. 341 44

Ampicillin resistance among strains of Hemophilus is usually due to production of beta-lactamase. This paper reports the isolation of a strain of H. parainfluenzae resistant to ampicillin with no detectable beta-lactamase or amidase activity. The organism, isolated from the blood of a patient who had aortic valve endocarditis, gave a zone diameter consistent with ampicillin sensitivity when tested by disc diffusion in Mueller-Hinton agar supplemented with 1% IsoVitaleX and 1% hemoglobin. Broth dilution testing in Levinthal medium, however, revealed the following minimal inhibitory cencentrations: ampicillin, 32 micrograms/ml; penicillin, 256 micrograms/ml; methicillin, 128 micrograms/ml; carbenicillin, 128 micrograms/ml; and cephalothin and chloramphenicol, 1.0 micrograms/ml. The results of acidimetric, iodometric, and chromogenic cephalosporin methods for detection of beta-lactamase were negative. Beta-lactamase activity could not be demonstrated in cell sonicates or induced by growth of the cells in antibiotic-containing medium. In addition, no extracellular degradation of either ampicillin or penicillin could be demonstrated.
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PMID:Ampicillin resistance in Hemophilus parainfluenzae. 696 94

Edwardsiella tarda is a recently identified gram-negative organism of the family Enterobacteriaceae. Reports of human infections with E tarda have been infrequent. We review 14 cases of systemic edwardsiellosis reported in the literature and report a case of E tarda osteomyelitis in a patient with sickle cell-hemoglobin C disease. In our case the remains of a snake may have been the source of the organism. Systemic edwardsiellosis is rare, and it may present as meningitis, endocarditis, bacteremia, liver abscess, or osteomyelitis. In 12 of 15 cases reported, systemic E tarda infection occurred in patients suffering from additional debilitating illnesses.
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PMID:Edwardsiella tarda osteomyelitis in a patient with SC hemoglobinopathy. 722 28

In a series of 416 women with congenital heart disease seen in the Royal Brompton National Heart and Lung Hospital, London, and the Hospital Giovanni Bosco, Torino, Italy, there were 822 pregnancies. The outcomes of 96 pregnancies in 44 patients with cyanotic congenital heart disease were studied. Patients with the Eisenmenger reaction were excluded. Patients were divided arbitrarily into groups according to the type of maternal congenital cardiac anomaly, and factors influencing maternal and fetal outcome were evaluated. The incidence of maternal cardiovascular complications was high (32%), with one death from endocarditis 2 months after delivery. Forty-one (43%) of 96 pregnancies resulted in a live birth; 15 (37%) were premature. Mean weight of full-term infants was 2575 g. Univariate analysis suggested that maternal disease, Ability Index, hemoglobin, and arterial oxygen saturation before the pregnancy were factors that discriminated between successful and unsuccessful fetal outcome, with hemoglobin and arterial oxygen saturation being the most important predictors. Women with cyanotic congenital heart disease can go through pregnancy with a low risk to themselves, with frequent treatable complications, but there is a high incidence of miscarriage, premature births, and low birth weights. An incidence of congenital heart disease in the fetus of 4.9% (2 of 41 live births) is higher than that found in the normal population.
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PMID:Pregnancy in cyanotic congenital heart disease. Outcome of mother and fetus. 820 80

A new diagnostic schema for infective endocarditis (IE), the Duke criteria, has been compared with the previously published criteria of von Reyn in adult patients. This study was designed to analyze the clinical characteristics of a group of pediatric patients with IE and to compare the diagnostic efficiency of both sets of criteria. We reviewed retrospectively the clinical records of 38 patients, 22 with predisposing heart disease (Subgroup A) and 16 with no known cardiologic abnormality (Subgroup B). Ventricular septal defect was the most frequent preexisting heart disease (31.8%) and central venous catheters were the most frequent predisposing factor (68.7%). Comparison of the clinical features between subgroups (A vs. B) showed differences only for the presence of a new regurgitant murmur (9% vs. 44%, P < 0.05) and a hemoglobin value < or = 10 g/dl (50% vs. 94%, P < 0.05). The most frequent microorganisms isolated were viridans streptococci (36%) in Subgroup A and Staphylococcus aureus (50%) in Subgroup B. Of the 6 pathologically confirmed cases all would have been classified as clinically definite by the Duke criteria, as compared with 2 of 6 being defined as probable and one being rejected by von Reyn criteria. Of the 32 cases clinically defined 19 (59%) were classified as definite by the Duke criteria, and 11 (34%) were probable by the von Reyn criteria (difference 25%, P < 0.01). Although no case of IE was rejected by Duke criteria, 8 (25%) were rejected by von Reyn criteria (difference 25%, P < 0.01), with all 8 classified as possible by Duke criteria. We conclude that the Duke criteria were superior to the von Reyn criteria for the diagnosis of pediatric IE, including more cases as definite and significantly fewer cases as rejected.
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PMID:Infective endocarditis in children: clinical analyses and evaluation of two diagnostic criteria. 874 22

In this paper we present a prospective evaluation of 100 patients with Group A Streptococcal (GAS) bacteremia evaluated in our hospital over a 10-year period. Sixty-two patients were intravenous drug users (IVDU); all but 1 of these had an obvious cutaneous portal of entry related to the injection of illicit drugs. Twenty-seven patients had infectious metastasis, and the presence of septic pulmonary embolism was associated with suppurative phlebitis. Four of these patients had endocarditis. In the non-IVDU group, 24 patients had an underlying disease, and 12 were immunosuppressed. In 14 cases the infection was of hospital acquisition; in 35% infection was related to medical manipulations. Comparing the IVDU and non-IVDU groups, GAS bacteremia in IVDU patients is associated with a more benign outcome, a longer time of evolution before diagnosis, and a lower frequency of septic shock and mortality than in non-IVDU patients. Although in the univariate analysis GAS bacteremia was associated with several variables, in the multivariate analysis only the presence of shock and nosocomial acquisition of the infection were independently associated with a fatal outcome. Fifty-two patients were infected with human immunodeficiency virus (HIV); 5 of these were in the non-IVDU group. During the last 5 years of study, GAS bacteremia in our hospital was 39 times more frequent in HIV-infected patients than in patients without HIV. Nine patients presented clinical criteria corresponding to Streptococcal toxic shock syndrome (STSS), although its incidence was lower in the IVDU group. In the non-IVDU group, STSS was more frequent in patients with a necrotizing portal of entry, an age between 20 and 40 years, women, and when the origin of the infection was the skin or soft tissue. Six patients with STSS died, and death was associated with the presence of necrotizing lesions and lower counts of white cells, platelets, or hemoglobin.
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PMID:Group A streptococcal bacteremia. A 10-year prospective study. 927 30

Jehovah's Witness who require operation represent a challenge to the physician because of the patients' refusal to accept blood transfusion. We report an 8-year-old male of Jehovah's Witness who underwent a surgical treatment of infective endocarditis. He was transferred to our hospital because of high fever and heart murmur. Echocardiogram revealed a developing vegetation of aortic cusps and an aneurysmal change of the non-coronary sinus Valsalva. On admission he was complicated by anemia, purulent meningitis and suppurative arthritis of left knee. There were no signs of cardiac failure. Erythropoietin (6000 U thrice weekly) and iron (60 mg daily) were given for 11 weeks prior to surgery, raising the hemoglobin level from 9.2 g/dl to 18.4 g/dl. Aortic valve replacement and plasty of the sinus Valsalva were then performed. Intraoperatively hemoglobin concentration dropped to 10.3 g/dl and it raised to 15 g/dl postoperatively. We also used Cell-Saver to reduce blood loss. The patient made an uncomplicated recovery. Erythropoietin therapy contributed substantially to the successful outcome of this case.
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PMID:[Open heart surgery in a Jehovah's Witness boy--a case report of successful management of aortic regurgatation and aneurysm of sinus Valsalva due to infective endocarditis]. 945 16

The infective endocarditis is a septic syndrome caused by an infection in endocardium or in heart valves. The majority of patients with infective endocarditis develop normocytic anemia. The metabolic studies in septic shock syndromes documented an intensive proteolysis of muscles, visceral organs and blood proteins, and probably of erythropoietin as a glycoprotein as well. The aim of the study was to assess the erythropoietin level in patients with infective endocarditis severe anemia and preserved renal function. Erythropoietin concentration was measured in blood serum in 12 patients (11 men and 1 woman), mean age 48 +/- 8 years, with infective endocarditis. The patients had clinical symptoms of endocarditis, positive blood bacteriological cultures and echocardiography features. All patients had serious normocytic anemia with mean hemoglobin concentration 5.40 +/- 0.48 mmol/L. The control group consisted of 7 healthy persons (5 men and 2 women), mean age 50 +/- 7 years, with hemoglobin concentration 8.70 +/- 0.60 mmol/L. The concentration of erythropoietin at the patients with bacterial endocarditis was 144.04 +/- 17.80 mIU/mL versus 67.28 +/- 6.29 mIU/mL in the control group (p = 0.0002). We conclude that in patients with infective endocarditis and serious normocytic anemia without renal insufficiency the concentration of erythropoietin is increased.
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PMID:[The level of erythropoietin in serum of patients with anemia during infective endocarditis]. 1072 24


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