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Reactive arthritis following infection with enteropathogenic bacteria is usually a self-limiting disease that disappears after a few months without sequela. We describe two girls who developed carditis shortly after the onset of reactive arthritis due to infection with Salmonella enteritidis. The carditis presented with fatigue and arrhythmia and involved the aortic valve in both patients leading to definite aortic regurgitation in one. A similar pattern of cardiac involvement is found in other spondyloarthropathies, including Reiter's syndrome and ankylosing spondylitis. We conclude that Salmonella reactive arthritis may be complicated by carditis.
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PMID:Reactive arthritis due to Salmonella enteritidis complicated by carditis. 784 47

We report a 46-year-old man with bacterial endocarditis and cardiac failure, who developed status epileptics. The patient was apparently well until July of 1991 when there was a gradual onset of fever and general fatigue. He was hospitalized to the cardiology service of our hospital where diagnosis of bacterial endocarditis and aortic insufficiency was made. On October 9, 1991, he suddenly developed cardiogenic shock, and emergency replacement of the aortic valve was made; at the operation, the main trunk of the left coronary artery showed embolic occlusion, and the myocardial movement was markedly diminished; serum creatine kinase was 3.150 IU/l. His cardiac failure did not resolve, and renal failure developed in December 1991, for which peritoneal dialysis was necessary. On February 2, 1992, he suddenly developed a clonic seizure which started from his face with a transient post-ictal left hemiparesis; a cranial CT scan was unremarkable. He was treated with phenytoin and glycerol, however, he developed status epileptics on February 3; he developed cardiac arrest after the injection of phenytoin 750 mg. He was resuscitated, however, his status did not resolve. Neurological consultation was asked on February 4. On physical examination, his blood pressure was 80/40 mmHg heart rate 77/min and regular, and body temperature 39.1 degrees C. The palpebral conjunctiva were slightly anemic, however, the bulbar conjunctiva were not icteric. No cervical adenopathy was noted. Glade II systolic murmur was heard in the apex; the lungs were clear. The abdomen was flat and soft without organomegaly. No edema was present in the legs. On neurologic examination, he was comatose without response to painful stimuli. He repeatedly had convulsion lasting for 30 seconds every 2 to 3 minutes; his convulsions started with the conjugate deviation of the eyes to the left followed by turning of the head toward left, and then clonic convulsions started in this left upper limb extending to other extremities. The optic fundi were unable to visualize because of corneal clouding; light reflex was sluggish on the right side; no oculocephalic response was elicited; corneal reflex was also lost bilaterally. Extremities were hypotonic, and no automatic movement was seen. The triceps brachii reflex was diminished, but all the other deep reflexes were lost; no plantar response was elicited. Meningeal sign was absent. He was treated with intravenous diazepam; the interval of convulsions prolonged, however, blood pressure dropped to 40 to 40 mmHg. On February 4, intravenous thiopental anesthesia was instituted, and assisted respiration was started.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[A 46-year-old man with cardiac failure and statues epileptics]. 794 26

Symptoms tend to develop late in the course of both chronic mitral and chronic aortic regurgitation, and when the regurgitation is stable patients may enjoy many years of full activity free from disability. In the absence of complicating atrial fibrillation or coronary artery disease the onset of dyspnoe and fatigue usually indicate myocardial failure and possibly a lost opportunity for a low risk operation and long term benefit. Valve replacement for aortic regurgitation is a good operation which reduces left ventricular work. However, mitral valve replacement is unphysiologic and not surprisingly, the operative mortality and long term results are worse with an excess of deaths caused by left ventricular failure. While the need for operation is obvious when patients already have symptoms or when valvar regurgitation is increasing, timing is far more difficult for patients with severe, chronic, stable regurgitation who still enjoy a high quality of life. It is even more difficult in mitral regurgitation because the stakes are higher with a higher operative risk, but suitability for mitral valve reconstruction justifies earlier operation and therefore makes it mandatory for cardiologists to identify such patients.
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PMID:Optimal timing of surgery for chronic mitral or aortic regurgitation. 826 Nov 61

A successful operation on a 49-year-old female with aortitis syndrome associated with prosthetic aortic valve detachment was reported. Aortic valve replacement using SJM 25A had been performed for aortic regurgitation caused by aortitis. Though her C-reactive protein (CRP) was kept between (+/-) and (2+) with prednisolone administered, general fatigue suddenly appeared 4 years after the first operation. The blood sedimentation rate was 65 mm/30 min and CRP was (4+), and the echocardiography showed abnormal movement of the prosthetic valve with perivalvular leakage on admission. Aortography showed the valve detachment and abnormal movement due to enlargement of sinuses of Valsalva, one of which was transformed as a diverticulum and projected into Left ventricular cavity with moderate leakage. After the inflammation was well controlled, she was operated upon. Dilatation of sinuses, perforation of intima around the prosthetic valve were recognized as left ventricular-aortic discontinuity, but ascending aorta was not enlarged. So the prosthetic valve was suspended below coronary ostia with transmural mattress sutures from right atrium. Postoperative course was uneventful. The postoperative aortography revealed only trivial perivalvular leakage without abnormal movement of the valve. This was a rare case of the valve detachment in the aortitis patient.
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PMID:[A case report--successful surgical treatment of prosthetic aortic valve detachment with enlargement of sinuses of Valsalva caused by the recurrence of aortitis]. 847 88

Primary hyperparathyroidism, characterized by hypersecretion of parathyroid hormone (PTH) leading to hypercalcemia and relative hypophosphatemia, is quite common in the elderly. Most patients with primary hyperparathyroidism have only mild hypercalcemia and are symptomless. But others experience various other organ diseases. Primary hyperparathyroidism is also associated with cardiovascular abnormalities, including QT interval shortening, heart block, cardiac arrhythmias, hypertension, myocardial hypertrophy, myocardial calcification and, though rarely, with valvular heart disease. We described a case of primary hyperparathyroidism associated with cardiac abnormalities. An 82-year-old male presented with the complaints of chest discomfort, fatigue, general weakness, nausea and vomiting over a period of months and was admitted in July 1996. Physical examination with heart auscultation showed a pansystolic murmur over the right sternal border and apex region, and a blowing diastolic murmur over the left sternal border. Biochemistry profiles revealed elevations of serum calcium (14.3 mg/dl) and chloride/phosphate ratio (> 33). Endocrinological studies showed elevations of serum PTH-C (4.8 ng/ml) and PTH-intact (705 pg/ml) concentrations. Kidney ultrasonography revealed a left renal stone. A spine X-ray revealed spondylosis and a compression fracture of the lumbar-spine with osteoporotic change. Thyroid ultrasonography and Thallium (Tl201)-technetium (Tc99m) subtraction scan showed parathyroid adenoma in the low pole of the right thyroid bed. Parathyroid aspiration cytology revealed few and discrete cells. Echocardiogram revealed moderate to severe aortic valvular calcification as well as stenosis with moderate aortic regurgitation, mitral regurgitation and myocardial calcification. The patient received parathyroidectomy one month later. During his postoperative days, he suffered from muscle twitching with positive Trousseau's sign and Chvostek's sign. The patient received calcium carbonate and vitamin D for hypocalcemia, diltiazem and capoten for his heart problems. A repeated echocardiogram two months after surgery showed no improvement of valvular calcification.
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PMID:Primary hyperparathyroidism with cardiac abnormalities: a case report. 950 84

Cardiac involvement in Whipple's disease is well established. However, clinical consequences beside antibiotic therapy have rarely been reported. Our observation of a middle-aged man with increasing dyspnea, fatigue, chest pain, and dizziness leading to admission to a cardiology department demonstrates that cardiac symptoms may represent the main symptoms in patients with Whipple's disease. The diagnosis was not made prior to upper endoscopy, performed because of diarrhea, and revealed Whipple's agent now classified as Tropheryma whippelii, which is a PAS-positive rod-shaped bacterium in the macrophages of the intestinal lamina propria. The aortic valve was replaced after the intestinal symptoms were resolved by antibiotic treatment reducing the number of infectious agents in the duodenal mucosa. Histological analysis of the aortic valve demonstrated the presence of PAS-positive rod shaped material as the most likely cause of aortic insufficiency. Five months after valve replacement, the patient had completely recovered from intestinal and cardiac symptoms. Still under antibiotic treatment 16 months later, no more PAS-positive macrophages were detectable in the intestinal mucosa.
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PMID:Whipple's disease with aortic regurgitation requiring aortic valve replacement. 964 12

Takayasu's aortitis is rare in male patients. The authors describe the case of a 48-year-old man with a fever of unknown origin, progressive general fatigue, and dyspnea due to aortic regurgitation. A severely thickened aorta was noted during aortic valve replacement. The diagnosis was based on a histologic examination of an operative specimen of the ascending aorta. Takayasu's aortitis should be considered even in male patients with fever of unknown origin and progressive aortic regurgitation.
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PMID:Unexplained fever and aortic regurgitation: a rare presentation of Takayasu's aortitis--a case report. 971 99

Cardiac valvular involvement associated with Wegener granulomatosis is uncommon. We describe a 17-year-old male adolescent who sought medical attention because of a sore throat, arthralgias, low-grade fever, and fatigue of 3 weeks' duration. A rash was noted on his elbows, hands, and ankles; subsequently, a crusting lesion was noted in his internal nares, and infiltrates were detected on chest radiography. Blood cultures were negative for pathogens. An echocardiogram disclosed mild left ventricular enlargement with grade 2 aortic insufficiency, and Wegener granulomatosis was diagnosed based on an antineutrophil cytoplasmic antibody titer of 1:512. When blood cultures are negative for aortic valve endocarditis, a high index of clinical suspicion and antineutrophil cytoplasmic antibody testing may lead to the diagnosis of acute aortic insufficiency associated with Wegener granulomatosis.
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PMID:Acute aortic insufficiency associated with Wegener granulomatosis. 1048 92

A 36 year old parturient with known valvular heart disease was admitted with respiratory distress and fatigue after 35 weeks of pregnancy. Echocardiography revealed severe tricuspid regurgitation, mitral stenosis and aortic valve insufficiency. Following clinical examination and insertion of a radial and pulmonary artery catheter it was decided to perform a Caesarean Section. The pulmonary artery pressure upon arrival in the operating theatre was 105/50 mm Hg whereas cardiac output was 3.5 l/min. Induction of anesthesia was performed with a target controlled infusion of remifentanil and propofol combined with rocuronium bromide. Haemodynamic variables remained very stable during and after intubation. The lungs of the apnoeic baby were manually ventilated until spontaneous respiration began at 1 minute post delivery. Apgar scores were 3, 7 and 9 after 1, 5 and 10 minutes respectively. Umbilical artery pH was 7.29. The patient's haemodynamic status gradually improved over the following few days. Two months following delivery she underwent unevenful valvular surgery.
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PMID:Target controlled infusion of remifentanil and propofol for cesarean section in a patient with multivalvular disease and severe pulmonary hypertension. 1153 14

We reported a successful case of emergent total arch replacement for a nonagenarian with acute Stanford A aortic dissection. A 92-year-old woman complained of general fatigue, with hypotension. Echocardiography showed moderate pericardial effusion and aortic regurgitation. Computed tomography (CT) scan showed widely extended aortic dissection from the ascending aorta to descending thoracic aorta, and cardiac tamponade. An emergent total arch replacement was performed under hypothermic selective cerebral perfusion with bladder temperature of 22.5 degrees C. Although she suffered from pneumothorax, renal insufficiency and gastrointestinal (GI) bleeding postoperatively, she tolerated the operation and complications, well. She is now leading a good life with the same level of activities of daily living (ADL) as preoperative one.
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PMID:[Successful total arch replacement for a 92-year-old woman with acute Stanford A aortic dissection: report of a case]. 1457 3


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