Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

From 1974 to 1984, 46 patients underwent emergency surgery for acute native valve endocarditis. Urgent valve replacement was necessary because of rapid hemodynamic deterioration in 34 (73%), uncontrolled sepsis plus heart failure in 9 (19%), and life-threatening emboli in 3 (7%) patients. At the time of surgery 23 patients (50%) were in NYHA functional class IV, 20 in Class III, and 3 in class II. Streptococcus was the most common organism encountered, followed by staphylococcus. Thirty-four cases presented severe aortic regurgitation, 3 mitral incompetence, 8 mitral plus aortic insufficiency, and one aortic plus tricuspid insufficiency. Operative mortality rate was 17% (8/46). Most deaths were due to preoperative multiple system deterioration, especially in cases with lesions of both the aortic and mitral valves, and were unrelated to the duration of preoperative antibiotic therapy. The postoperative observation period of long-term survival is from 6 to 102 months (= 44 months). There were 7 late deaths. The actuarial survival, including operative mortality, is 67%. Twenty-two patients are now in NYHA class II, 6 in class III. The duration of postoperative antibiotic treatment (6 weeks in our series) seems to be important for the prevention of reinfection, early surgery is of great benefit; our 31 survivors showed an excellent clinical improvement.
 ...
PMID:Valve replacement in acute native valve endocarditis. 242 26

The efficacy, morbidity, and 1-year follow-up of balloon aortic valvuloplasty in patients with low ejection fraction (less than 40%) were studied on a consecutive series of 55 patients (mean age, 77 years) treated from September 1985 to February 1987. Because of their age (20 patients greater than 80 years old), poor left ventricular function, and associated diseases, 45 patients were definitely not surgical candidates. Balloon dilatation with 15-23-mm diameter balloon catheters decreased the transvalvular gradient from 66 +/- 24 to 28 +/- 14 mm Hg (p less than 0.001) and increased the valve area from 0.47 +/- 0.15 to 0.83 +/- 0.27 cm2 (p less than 0.001). Immediately after dilatation, ejection fraction mildly increased from 29 +/- 7% to 34 +/- 9% (p less than 0.001) in 38 patients who had undergone a second left ventricular angiogram after dilatation. No significant change in the degree of aortic regurgitation was found after the procedure. Three patients died in hospital (femoral arterial complications in two, septicemia in one). Immediate clinical improvement was noted in 80% of the patients. During the follow-up (mean, 11 months), 22 patients died (heart failure in 15 patients, sudden death in five patients, myocardial infarction in one patient, cancer in one patient). Thirty patients survived, 21 with persistent clinical improvement. Repeat cardiac catheterization was performed at 6 months in 20 patients, of whom eight had recurrence of symptoms. Nine patients had restenosis: their hemodynamic indexes had returned to prevalvuloplasty values.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:Percutaneous balloon valvuloplasty in patients with severe aortic stenosis and low ejection fraction. Immediate results and 1-year follow-up. 247 May 29

Following percutaneous transluminal aortic valvuloplasty, 2/100 patients (2%) developed significant aortic insufficiency as a result of an aortic annular tear. Both patients underwent emergency aortic valve replacement and survived the operation. One patient died 4 weeks postoperatively from sepsis and multiorgan failure, and the other patient had a benign postoperative course. In both cases, the balloon area significantly exceeded the aortic annular area and caused the complication. Review of the balloon area-aortic annular area ratio in our series showed that a value of less than 1.2 was not associated with this complication.
 ...
PMID:Aortic annular tear after valvuloplasty: the role of aortic annulus echocardiographic measurement. 291 17

Infectious endocarditis is occasionally a complication of Staphylococcus aureus sepsis in previously well individuals with no heart disease or history of intravenous drug use. We report a case of a 16 year old who developed Staphylococcal sepsis and endocarditis probably as the result of neglected paronychia of her toes. Despite adequate antibiotic therapy, the infectious process destroyed her aortic valve, thereby producing aortic regurgitation complicated by cerebral embolism. Aortic valve replacement surgery was required. Endocarditis should always be sought with S. aureus bacteremia. Intravenous high-dose antibiotic therapy for at least 4 weeks is the recommended therapy.
 ...
PMID:Staphylococcus aureus endocarditis in a previously healthy adolescent. 341 9

Ten infants with critical aortic stenosis underwent transventricular valvotomy between November 1983 and September 1984. The ages of the patients ranged from 1 to 38 days (mean 21.2 days). Three patients were less than 1 week of age. One had undergone a previous valvotomy performed with inflow occlusion. Most infants were critically ill when admitted to the hospital, six required inotropic and ventilatory support, and two had peritoneal dialysis before the operation. Transventricular valvotomy was performed through a left thoracotomy with Hegar dilators. Postvalvotomy peak-to-peak gradients ranged from 0 to 35 mm Hg. Three patients died at 2, 3, and 6 weeks after operation. A severe degree of endocardial fibroelastosis was present in one patient, and a second patient died of septicemia caused by wound infection, empyema, and a bronchopleural fistula. Severe left ventricular hypertrophy, with moderate fibroelastosis, was found at autopsy in the third patient. Aortic incompetence was not detected postoperatively. One patient required reoperation 7 months after the transventricular valvotomy. Transventricular valvotomy has proved to be a simple and effective technique to relieve aortic stenosis in sick infants. It permits the correction of associated coarctation of the aorta and avoids a median sternotomy. Results are comparable with the results obtained with either cardiopulmonary bypass or inflow occlusion as seen in both our experience and in the experience of others.
 ...
PMID:Transventricular aortic valvotomy for critical aortic stenosis in infants. 356 Oct 1

Our experience with the Bentall and DeBono procedure is reviewed. Between April, 1977 and April, 1985, seventeen patients underwent repair of annulo-aortic ectasia (9 cases), and dissecting aneurysm with aortic regurgitation (8 cases). Three patients had cardiac tamponade due to rupture of dissecting aneurysm. In regard to this procedure, we recently performed the continuous suture method on the prosthetic valve ring, coronary ostia, and distal anastomosis sites. In this study, there was one early death due to a sudden rupture of the dissecting aneurysm of the left thoracic cavity on the 10th postoperative day. In addition, there were two late deaths due to sepsis and suspected arrhythmia. The late follow-up period ranged from 6 months to 8 years (mean 35 months), and all patients were in NYHA Class I or II. We conclude that the composite valve graft method is an excellent technique for annuloaortic ectasia and ascending aortic dissections with aortic regurgitation because of its low operative mortality and fair survival rate.
 ...
PMID:Surgical consideration of replacement of the ascending aorta and aortic valve with a composite valve graft--operative and long-term results of Bentall and DeBono procedure. 366 68

A 54 year old man, hospitalised for thoraco-abdominal pain resulting from a septicemia which gives positive hemocultures for streptococcus D Bovis, is diagnosed to have a splenic abscess which will require splenectomy. At the same time, an endocarditis develops and gets worse, with auriculo-ventricular blockade and, especially, major aortic insufficiency, which is the cause of death by a brutal and massive pulmonary oedema. In the progression of an endocarditis, the occurrence of a splenic abscess, primary localisation of the initial septicemia or the secondary of an arterial septic embolism, is a rare contingency compared to the frequency of splenomegaly or splenic infarction: less than 2 percent of the cases in the literature. This very atypical and exceptional case serves as a reminder, on the one hand, of the diagnostic inadequacy of echocardiography which cannot visualise vegetation in the course of progressive endocarditis, and, on the other, of the prognostic importance of auriculoventricular blockade in septal and aortic endocardial lesions.
 ...
PMID:[Splenic abscess disclosing endocarditis]. 393 91

Amongst 9000 patients on whom angiocardiograms had been carried out, a membranous septum aneurysm (MSA) was found in 47. In nine patients out of 27 the MSA could be demonstrated by sonography. The most common abnormalities accompanying this lesion were disturbances in rhythm and conduction (in 29 patients), ventricular septal defect in 29 and aortic insufficiency in 14. Complications included bacterial endocarditis in five patients (three with aortic insufficiency and two with sepsis lenta), aortic insufficiency (which was not of rheumatic or bacterial origin in three patients with conduction defects) and thirteen patients with abnormalities of cardiac rhythm with small VSDs.
 ...
PMID:[Aneurysm of the membranous septum. Angiocardiographic study]. 642 Feb 75

Since the introduction of effective antimicrobial therapy, the leading cause of death in patients with infective endocarditis is no longer sepsis but, rather, congestive heart failure. The mortality is higher in patients with severe heart failure due to infective endocarditis who are treated with medical therapy only than in those who additionally undergo cardiac valve replacement. The mortality is also higher in patients with severe heart failure due to aortic infective endocarditis (40 to 93%) than in those with heart failure due to mitral infective endocarditis (17 to 66%). In patients with and in those without infective endocarditis, surgical intervention can be carried out with comparable mortality not only for aortic valve replacement (9 vs 8.4%) but also overall for valve replacement (10 vs 12%). In patients with class IV heart failure, overall mortality of valve replacement was higher (17%) than in patients with class II (8%) or class III heart failure (7%) and, similarly, comparable with that of matched groups of patients without infective endocarditis. In patients with class IV disability, the mortality of valve replacement was higher in those with active infective endocarditis (19%) than in those with inactive infective endocarditis, possibly due to a higher incidence of sudden onset of severe aortic regurgitation and myocardial abscess. No patient with valve replacement for inactive infective endocarditis developed prosthetic valve endocarditis; a single case of prosthetic valve endocarditis occurred in a patient with active infective endocarditis. In general, early surgical intervention is preferable to procrastination in the management of patients with progressive or severe heart failure due to infective endocarditis. Although, in at least 70% of patients, blood cultures may be rendered sterile within one week of initiation of appropriate antimicrobial therapy, patients with infective endocarditis due to staphylococci, multiply-resistant gram-negative bacilli, fungi, Q-fever or those with myocardial abscess or multiple relapses may require surgical intervention. While the overall incidence of clinically apparent emboli has been reported to be as high as 30%, in a ten-year observation period at the Mayo Clinic, the rate was 5.6%. Patients with echocardiographic evidence of large or mobile vegetations and those with infective endocarditis cause by microorganisms associated with a high risk of embolization such as slow-growing fastidious gram-negative bacilli, fungi (especially Aspergillus) and nutritionally-variant viridans streptococci should be considered candidates for surgery irrespective of a history of emboli.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Cardiac valve replacement in patients with active infective endocarditis. 666 78

Aortic valve replacement with a pulmonary autograft was performed in 24 patients between October 1993 and October 1994, at the All India Institute of Medical Sciences, New Delhi. There were 20 (83.3%) males and 4 (16.7%) females. Their ages ranged from 10 to 56 years (mean, 21.46 +/- 11.45 years). Associated procedures included 10 mitral valve procedures (4 open commissurotomies, 5 mitral valve repairs, and 1 homograft mitral valve replacement) and 1 tricuspid valve repair. There were 4 (16.7%) early deaths, 3 of which were due to bleeding or its sequelae and 1 due to septicemia. There were no late deaths. Follow-up ranged from 1 to 13 months (mean, 198.3 +/- 111.1 days). Nineteen (95%) patients are in New York Heart Association functional class I, and 1 patient (5%) is in class II, due to poor left ventricular function. Only 1 patient showed grade 2/4 aortic regurgitation on follow-up examinations, and none has shown progression of aortic regurgitation. Our early results with the pulmonary autograft are encouraging; however, long-term evaluation is needed.
 ...
PMID:Pulmonary autograft aortic valve replacement. Early experience with the Ross procedure. 764 2


<< Previous 1 2 3 4 5 Next >>