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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty patients were operated on in the early phase of active endocarditis between 1980 and 1988. Indications for operation were heart failure (30 patients), severe valvular regurgitation (4), uncontrolled sepsis (2), septic emboli (3), and other (1 patient). Time between onset of endocarditis symptoms and operation ranged from 12 to 45 days (mean, 30 days). The aortic valve was involved in 3 patients; the mitral valve, in 28; both valves, in 7; and the tricuspid valve, in 2. There was no previous underlying valve pathology in 40%. Lesions found were cusp perforation (17 patients), annular abscess (4), vegetation (13), and chordal rupture (22). Positive blood cultures were found in 30 patients (75%). Bacterial findings were Streptococcus in 12 patients (30%), Staphylococcus in 15 (37.5%), gram-negative in 3 (7.5%), and unknown in 10 (25%). Criteria to perform valve repair were adequate antibiotic therapy for at least 1 week and large excision of all macroscopically involved tissues. In all cases, Carpentier's reconstructive techniques were used. Perioperative mortality was 2.5% (1 patient). Reoperation was necessary in 1 patient. Late mortality was 2.5% (1 patient). Repair was assessed either by angiography or by Doppler echocardiography before hospital discharge: 32 patients showed no regurgitation, whereas 7 had mild regurgitation (3 aortic, 4 mitral). Mean follow-up of 30 months was achieved in all survivors. There was no recurrence of endocarditis and no reoperation for valvular insufficiency. We conclude that valve repair in acute endocarditis is possible and effective in most instances.
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PMID:Valve repair in acute endocarditis. 233 26

The authors used microcholangiography to demonstrate the feasibility of the technique and the features of the normal and the obstructed biliary systems. Furthermore, they attempted to explain the pathophysiology of cholangiography-related septicemia with this technique. Extrahepatic bile ducts (EHBD) of 40 rabbits were ligated, and microcholangiography was carried out with infusion of barium suspension immediately as well as one, three, and five days after ligation. Microradiographic technique was used and the findings were correlated with histopathologic features. The intrahepatic microbiliary system such as interlobular bile ducts and ductules were well visualized. After EHBD ligation, ductules were tortuously dilated. The histologically observed ductular proliferation in many hepatobiliary diseases could be attributed in part to the tortuosity of bile ductules, particularly when biliary obstruction is present. Regurgitation of barium into hepatic sinusoids was demonstrated in 36 rabbits (90%) and probably was caused by rupture of interlobular bile ducts and ductules.
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PMID:Microcholangiography. Normal microbiliary system and its alteration after extrahepatic bile duct obstruction. 252 Nov 26

During a 12 year period from 1974 to 1986, 38 patients with native valve infective endocarditis were treated surgically. All patients were in the active phase of infection at the time of surgery. Surgical intervention was performed as an extreme emergency in 21 patients, 10 patients were operated on the next day, and 7 patients underwent elective surgery within 3-4 days. Indications for operation were heart failure alone in 52% of patients, heart failure accompanied by sepsis and emboli in 42% and uncontrolled sepsis in the remaining 6% of patients. The hospital and late mortality was 10.5% and 5.2% respectively. Recurrence of infection and paravalvular regurgitation was only seen in one case. Thus, we believe that the risk of surgical intervention for infective endocarditis can be minimised if operative treatment is carried out early, before advanced haemodynamic and irrevocable valvular deterioration ensues.
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PMID:Operative considerations in active native valve infective endocarditis. 274 14

A review of 13 autopsy specimens and of 13 patients who were operated on for complete atrioventricular (AV) canal and tetralogy of Fallot between 1975 and 1985 revealed a number of anatomical details that are important in the successful repair of this combined lesion. A bridging anterior leaflet was present in 25 hearts. A septum primum was present and attached to leaflet tissue in 13. In all 26, a ventricular septal communication was present beneath the bridging anterior leaflet and extended anteriorly, but in 14 there was no ventricular septal defect underneath the posterior leaflet. Additional pathological features included the following: leaflet tissue deficiency (4 hearts), single left papillary muscle (3), accessory valve orifice (4), and left ventricular (4) or right ventricular (RV) (1) dominance. All 26 had infundibular stenosis, and 10 had hypoplastic pulmonary annuli. One had pulmonary atresia, and 6 had branch pulmonary artery stenosis. Surgical technique was modified to include incision of the septum primum in 7. Because of rightward displacement of the anterior ventricular septum and also to minimize the risk of causing subaortic stenosis, the bridging anterior leaflet was divided more toward the tricuspid orifice so as to parallel the crest of the ventricular septum. Transannular RV outflow patches were used in 10 patients, and a right ventricle-pulmonary artery conduit was placed in 1 patient. Three required repair of branch pulmonary artery stenosis. There were no hospital deaths. Three patients died late of residual AV valve regurgitation and branch pulmonary artery stenosis (2) and sepsis (1).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Complete atrioventricular canal and tetralogy of Fallot: surgical considerations. 375 74

The surgical management of severely symptomatic newborn infants with tetralogy of Fallot and absent pulmonary valve has been controversial, and the results of a variety of operative approaches have not been satisfactory. We report on a technique for the treatment of these patients, which consists of (1) ligation of the main pulmonary artery to eliminate pulmonary regurgitation, excessive right ventricular stroke output, and secondary pulmonary artery dilation and airway obstruction and (2) insertion of a subclavian-pulmonary artery polytetrafluoroethylene shunt to provide pulmonary blood flow. The procedure was used in four neonates. Two patients operated on at 2 and 3 days of age are doing well 15 and 19 months postoperatively. The other two, operated on at 3 and 4 weeks of age after unsuccessful prolonged medical treatment and positive-pressure ventilation, failed to show long-term improvement and died of sepsis and respiratory failure 3 and 5 months after operation. This experience, though limited, suggests that early surgical intervention to control pulmonary regurgitation prevents progressive pulmonary artery dilatation and secondary bronchial compression, decreases the need for prolonged preoperative and postoperative ventilation, and improves the outcome of these critically ill neonates.
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PMID:Surgical approach to severely symptomatic newborn infants with tetralogy of Fallot and absent pulmonary valve. 395 78

Although the legalization of abortion has almost eliminated the risk of mortality, the experience is still psychologically difficult for many women, increasing the need for sympathetic treatment by the staff. Intraoperative complications may result from regurgitation, cardiovascular irregularities, or allergic reaction caused by the general anesthesia usually employed; from uterine perforation by the operative instruments, most commonly among multiparas and women who have undergone cesareans or have a uterine infection; or uterine hemorrhage. Uterine perforation is usually evaluated by celioscopy and may require surgical intervention if bleeding occurs. Infection and peritonitis may result from perforation. Complications of anesthesia may be reduced by using local anesthetic, while complications of uterine perforation may be reduced by careful examination of the patient under general anesthesia before the procedure begins. In the event that no products of conception are recovered, the instruments must be checked for malfunction, evidence of pregnancy should be reexamined, and ectopic pregnancy ruled out through clinical examination and celioscopy. Immediate postoperative complications may include uterine or tubal infection caused by retention of debris or perforation, peritonitis, and septicemia, and can result in secondary sterility. Continuation of the pregnancy is a rare complication. Late complications may include sterility due to cervico-isthmal weakening, uterine synechia, tubal occlusion, or psychological factors.
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PMID:[Complications of voluntary interruption of pregnancy]. 692 92

The clinical course of 22 patients with acute endocarditis treated surgically less than six weeks after the onset of antibiotic therapy was reviewed. The aortic valve was infected in 13 patients, the mitral in six, the tricuspid in two, and one patient had both aortic and mitral valve involvement. The indications for surgical intervention before the completion of adequate antibacterial therapy included uncontrollable congestive heart failure, persistent sepsis, systemic embolization, and multiple septic pulmonary embolizations. The annulus was involved by the infectious process in five of the 13 patients with aortic valve endocarditis, in one of the two patients with tricuspid valve infection, and in none of the patients with mitral valve endocarditis. There were two surgical deaths, for a mortality of 9.1%. During the follow-up period, four patients died three months, seven months, four years, and seven years after surgery. The remaining patients have been followed up for a period of five months to 10 years. One patient has a hemodynamically insignificant paravalvular leak, and another developed paravalvular regurgitation and a false aneurysm of the left sinus of Valsalva two weeks after the initial operation. She subsequently underwent successful valve replacement and repair of the aneurysm. This study confirms that valvular replacement should be done for acute endocarditis as soon as indicated, and that the incidence of reinfection and/or the development of valvular or paravalvular problems is small even in the patients with incomplete antimicrobial therapy, whether or not the annulus is involved by the infectious process.
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PMID:Immediate and long-term outlook for valve replacement in acute bacterial endocarditis. 708 64

From August 1974 through April 1981, 23 patients, ages 5 months to 40 years (median 11 years) with corrected transposition of the great arteries (C-TGA), underwent repair of associated intracardiac defects: 20 for ventricular septal defect (VSD), 19 for pulmonary outflow tract obstruction, and five for anatomic tricuspid valve regurgitation. Segmental anatomy was [S,L,L] in 18 or [I,D,D] in 5. Pulmonary outflow tract obstruction was resected in 10 and bypassed with a left ventricle-to-main pulmonary artery conduit in nine patients. Hospital mortality was 9% (two of 23). One patient died from arrhythmia and one from sepsis and arrhythmia. The late mortality rate was 14% (three patients). Two patients died from severe pulmonary vascular obstructive disease (5 months and 2 years postoperatively) and one from arrhythmia (2 months postoperatively). Fourteen have undergone cardiac catheterization 3 days to 4 years (mean 12 months) postoperatively. Three had a small residual VDS (Qp/Qs less than 1.5). Five had residual pulmonary outflow tract obstruction (peak systolic ejection gradient 30-130 mm Hg) after resection or pulmonary valvotomy. One patient had reresection and four had placement of a secondary left ventricular-pulmonary artery conduit. Anatomic tricuspid valve regurgitation became severe in three patients after VSD closure, two of whom required valve replacement; the other died of coexisting pulmonary vascular obstructive disease. Five with [S,L,L] segmental anatomy had complete atrioventricular block preoperatively and six developed complete atrioventricular block at surgery. Eleven of 18 patients with [S,L,L] anatomy had atrioventricular spontaneous or iatrogenic complete block; none of the five patients with [I,D,D] anatomy had atrioventricular block. Pulmonary outflow tract obstruction in [S,L,L] segmental anatomy required conduit interposition in 12 of 14 of our patients to significantly decompress the ventricle. Postoperative development or exacerbation of anatomic tricuspid valve regurgitation occurs in TGA [S,L,L] and may be causally related to surgical complete atrioventricular block.
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PMID:Corrected transposition and repair of associated intracardiac defects. 708 42

Between 1985 and 1992, 36 consecutive neonates, aged 1-29 days, weight 2.4-5.0 kg, with critical valvar pulmonary stenosis underwent attempted balloon dilation (BD). At catheterization, 30 were on prostaglandin (PGE1) therapy and 20 were intubated. The valve was successfully crossed and dilated in 34/36 (94%), including three with an echocardiographic diagnosis of valvar pulmonary atresia and a right ventricle of adequate size. The valve was first dilated with a 2- to 5-mm balloon and then with serially larger ones (up to 12 mm) to a final balloon/annulus value of 126%. The RV/systemic pressure value fell from 150 +/- 32 to 83 +/- 30%, O2 saturation rose from 91 +/- 6% to 96 +/- 4%, and PGE1 was discontinued at the end of the procedure. There were 11 complications (31%) including one early death from sepsis and necrotizing enterocolitis, endocarditis in another, two myocardial perforations, one femoral-iliac vein tear, and one transient pulse loss. A repeat BD was carried out in five patients, two of whom subsequently had surgery. At follow-up (33 +/- 23 months), the 31 patients managed by BD alone were well and had echocardiographic gradients of < 30 mm Hg in 90% and pulmonary regurgitation, considered mild in most, in 52%. In neonates with critical valvar pulmonary stenosis, we believe BD mortality is less than with surgery and is the treatment of choice.
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PMID:Balloon dilation of critical valvar pulmonary stenosis in the first month of life. 772 47

Valve repair is often required to maintain haemodynamic performance in patients with infectious endocarditis. Localizations on the aortic valve are frequent and lead to rapid, often severe, deterioration, especially when the valve ring and the septum are also infected. Conduction disorders and rupture of the abscess into the heart cavities are formal indications for surgery. Mitral regurgitation requires surgical repair less often and has a slower clinical course. The tricuspid valve generally tolerates infection well and surgery is only exceptionally indicated. An emergency situation due to heart failure occurring simultaneously with valve damage (ruptured mitral chordae) and moderate regurgitation, can most often be managed medically. Inversely, surgery is required when blood cultures are persistently positive and sepsis remains uncontrolled after 8 days of adapted antibiotics. Surgery is entertained when the risk of emboli is established echographically, although growth on valves is not in itself sufficient. Most operated cases also involve an initial embolic event. Conservative surgery (mitral or tricuspid plasty) should always be performed to avoid the long-term complications of prostheses: valve dysfunction (disinsertion or thrombosis), bacterial resistance, risk of embolism especially for mechanical valves, risk of brain haemorrhage related to anticoagulant therapy. When endocarditis develops on a prosthesis early after implantation reoperation is usually required, especially when certain organisms (yeasts, Staphylococcus aureus) are involved. Haemodynamic performance and bacterial resistance dominate the decision making processes which must be adapted to each individual case. Once the decision for surgery has been made, the operation should not be delayed in the hope a longer antibiotic course will be effective since prognosis worsens rapidly if the haemodynamic situation is allowed to deteriorate.
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PMID:[Infectious endocarditis: the right time for surgery]. 789 43


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