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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The abdominal left ventricular assist device (ALVAD) is an order of magnitude more effective than conventional intra-aortic balloon pumping (IABP) in unloading and providing circulatory support to the failing left ventricle. This is a report of a unique case which demonstrates that in the absence of pulmonary vascular obstruction or constriction, the ALVAD can substitute for both left and right heart function. A 21-year-old patient with a congenital bicuspid aortic valve developed acute valvular endocarditis which rapidly progressed to congestive heart failure. An operation was undertaken, the mitral and aortic valves were excised and replaced by porcine heterografts, and a fistula from the right sinus of Valsalva to the right ventricle was closed. When coronary circulation was restored, irreversible ischemic contracture of the left ventricle, or "stone heart" syndrome, developed and emergency ALVAD or partial artificial heart implantation was effected. This device functioned as a total artificial heart for nearly six days, while a donor heart was sought. The patient then underwent removal of the ALVAD and cardiac and renal allografting. The transplanted heart functioned well, but the patient expired fifteen days later from gram-negative sepsis.
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PMID:Partial artificial heart (ALVAD) use with subsequent cardiac and renal allografting in a patient with stone heart syndrome. 36 90

Human infection with Pasteurella multocida is the leading cause of animal bite wound infection. Life-threatening infection may occur in patients with a variety of underlying disorders and an immunocompromised state. Infective endocarditis with P. multocida is very rare and only a few clinically diagnosed cases have been reported. Described here is an autopsy case of a 61-year-old man with polycystic kidney disease who had P. multocida bacteremia and acute infective endocarditis with multiple bacterial clumps involving bicuspid aortic valve. The organisms were gram negative. Apparently the sepsis with P. multocida was acquired via licking of leg ulcers by his pet dog, establishing an animal-related causal relationship. Because P. multocida is a very common flora of many animals, infection with this organism probably occurs more frequently than is commonly appreciated. High index of suspicion and early diagnosis, especially in immunocompromised patients, are warranted because the disease is potentially life threatening, yet is a readily treatable infection.
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PMID:Pasteurella multocida endocarditis. 146 53

Thirteen cases of infective endocarditis (IE) diagnosed for the first time at autopsy or, in those patients with a previous diagnosis of IE, not thought to be active at the time of death, are presented. Of the six patients who died within 24 h of the onset of symptoms, two died of obstruction of a valve orifice, two died of sepsis, one died of sepsis and alcoholic cardiomyopathy, and one died of a coronary artery embolus. Of the five patients with symptoms lasting more than 24 h, three died of sepsis and congestive heart failure. One died from sepsis alone and one died from congestive heart failure (CHF). In two patients whose duration of symptoms is unknown, one died of sepsis and CHF, and in the other the mechanism of death is unknown. Predisposing factors present in 11 of 13 patients included alcoholism (three), intravenous (IV) drug abuse (three), prosthetic valves (three), aortic stenosis (two), past rheumatic fever (one), and nonstenotic congenitally bicuspid valves (two). The reasons for no antemortem diagnosis were a missed or incorrect clinical diagnosis in three patients seen by a physician shortly before death, no signs or symptoms or found dead (four), non-specific signs and symptoms (three), refusal of medical treatment (one), and a solitary lifestyle (one); there was insufficient information about one patient. Individuals with needle tracks, generalized petechiae. Osler's nodes, splinter hemorrhages, intravenous catheters, pacemaker wires, and infected aortic-valve (A-V) shunts are at risk of IE. Blood and the vegetations should be cultured. The attending physician should be notified of the diagnosis in such cases.
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PMID:Unexpected death as a result of infective endocarditis. 258 45

Twenty specimens of heart with mycotic aneurysms at the aortic root were studied. In ten cases, mycotic aneurysm followed infection of the aortic valve. In one case, it developed following infection of an aortic jet lesion, and in nine patients, the aneurysm was at the seat of a prosthetic aortic valve. In seven of the 11 cases with a natural aortic valve, the valve was either unicuspid or bicuspid. A retrospective evaluation of the data on the clinical records of the 20 patients revealed that infective endocarditis or noncardiac postoperative sepsis was present in 11. The most frequently isolated microorganism was Staphylococcus aureus. Conduction disturbances were found in six patients, all of them with involvement of the atrioventricular node by the aneurysm. Perforation into intracardiac cavities was found in four, two into the right ventricular infundibulum and one each into each atrium. Pericardial tamponade was caused by bleeding from the aneurysm in two cases, and myocardial infarction was a probable consequence of coronary arterial compression by the aneurysm in two cases. Mycotic aneurysms of the aortic root, in spite of their being partially or completely healed of active infection, carry a high risk of the complications enumerated. Among the 20 cases, cultures were positive in 11 and negative in nine. Staphylococcus aureus was cultured from five of the cases.
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PMID:Mycotic aneurysms of the aortic root. A pathologic study of 20 cases. 375 65

In a retrospective study of 50 patients with infective endocarditis (IE), we found an overall mortality of 44%: among the 26 patients with natural valves (NV) the mortality was 19%; among the 24 with prosthetic valves (PV) it was 71%. Congenital heart disease was recognized in 17 of our cases, with a significant clustering in the NV group (50% vs 17%, p = 0.029); the most frequently encountered malformation was the bicuspid aortic valve. The incidence of rheumatic heart disease was 46% in the NV group and 83% in the PV group (p = 0.015). Manifestations of IE were protean and multisystemic. We calculated an average of 4.6 symptoms and 4.7 signs for each patient. Although sepsis was abated with appropriate antibiotics, death often ensued from multiple complications: congestive heart failure, arrhythmia, stroke, embolic myocardial infarction, valvular destruction or dehiscence, coagulopathy. New features of natural valve infective endocarditis are a rising incidence in the elderly and a survival rate seemingly at its peak. Features of prosthetic valve infective endocarditis include overwhelmingly frequent embolization to the central nervous system (p = 0.004), spleen (p = 0.009) and kidney (p = 0.010). Advances in therapy for this disease may come from early surgery in late prosthetic valve endocarditis and from future prospective studies to define how the host response influences the outcome.
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PMID:Infective endocarditis update experience from a heart hospital. 697 38

Between January 1992 and June 1994, 23 patients underwent surgery for aortic valve endocarditis at the Department of Cardiovascular Surgery of the University of Verona; a subgroup of 10 patients underwent aortic valve replacement with a porcine stentless valve (Biocor LTDA n = 8; Toronto SPV n = 2). There were 7 males and 3 females with a mean age of 56.3 years (range, 36 to 73 years). Eight patients had active endocarditis and two had healed endocarditis. Nine patients had native valve in endocarditis, the presence of a bicuspid aortic valve in 2, and 1 patient had recurrent prosthetic valve endocarditis (PVE), 7 of whom were in New York Heart Association (NYHA) Functional Class IV. The main indications for operation were congestive cardiac failure, active sepsis, and presence of large and mobile vegetations by echo and arrhythmias. There were no operative or late mortalities in this subgroup of patients. Short-term survival is 100% at a mean follow-up time of 11.2 months (range, 4 to 18 months), with no recurrent endocarditis or valve-related complications.
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PMID:Stentless porcine bioprostheses in the treatment of aortic valve infective endocarditis. 762 70

Coronary complications after aortic root replacement (ARR) with pulmonary autografts have been reported to be more common than with other stentless biological conduits (homografts, xenografts). To verify this hypothesis, results with 84 consecutive patients having stentless ARR between January 1992 and January 1999 were reviewed. Fifty patients had autograft (Group 1) and 34 either homograft or xenograft (Group 2) ARR. Comparison of age (27+/-9 vs. 38+/-22 years, P = ns), prevalence of male sex (86% vs. 79%, P = ns), aortic root disease (30% vs. 44%, P = ns), congenital coronary anomalies (10% vs. 3%, P = ns), prior aortic procedure (16% vs. 15%), and need for associated procedures (26% vs. 24%, P = ns), did not disclose significant differences. Bicuspid aortic valve was more prevalent in Group 1 (56% vs. 9%, P = .001). Mean aortic crossclamp (154+/-28 vs. 120+/-24 minutes, P = .05) and bypass (216+/-30 vs. 192+/-58 minutes, P = .05) times were longer in Group 1. Early mortality was comparable (2% vs. 3%, P = ns) and caused by right ventricular ischemia in both groups. Overall prevalence of coronary complications was higher in Group 1 (10% vs. 3%, P = .04), all resulting in right heart ischemia. Intraoperative partial takedown of repair in 5 Group 1 patients, associated with CABG in 1, resulted in prompt resolution of myocardial ischemia in 4 (80%) and prolonged in 1, which ultimately died as a result of sepsis. Recovery was prompt in all 4 patients (mean ICU stay 35+/-28 hours) with no metabolic or echocardiographic evidence of myocardial infarction. At discharge echocardiography, satisfactory biventricular kinetics was found in all patients. Analysis of preoperative variables showed bicuspid aortic valve (83% vs. 33%, P = .01) and coronary anomalies (67% vs. 3%, P = .001) to be more prevalent in patients suffering from coronary complications. Stentless ARR is a safe procedure with low operative mortality, regardless of the type of biological conduit. Autograft ARR may be at greater risk of right ventricular ischemia in patients with bicuspid aortic valve and coronary anomalies. An aggressive intraoperative approach including partial takedown of repair may limit the morbidity of coronary complications.
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PMID:Risk factors for coronary complications after stentless aortic root replacement. 1066 Jan 80

A 29-year-old female was admitted with fever, purpura and hemiparesis. She was treated for meningococcal sepsis after a Gram stain of a purpuric lesion showed Gram-negative diplococci. CT scan of the brain revealed multiple haemorrhagic lesions with obliteration of the sulci and basal cisterns. In the course of the disease she developed an acute myocardial infarction. Besides wall motion abnormalities, echocardiography revealed a bicuspid aortic valve with a vegetation on one of its cusps. Despite these findings, both the doctors who were involved in the treatment of this patient and the consulted physician in this article failed to reject the diagnosis 'meningococcal sepsis' and to replace it with a more likely diagnosis, namely Staphylococcus aureus endocarditis. The patient died one day after admission due to transtentorial herniation. Although purpuric lesions are common in meningococcal sepsis, they are not specific for this disease. The false-positive result of the Gram stain resulted in a process known as 'premature closure': the diagnosis of meningococcal sepsis was accepted before it was fully verified. In this case, the consequence was that other diagnostic tests and symptoms were misinterpreted with the result that inappropriate antibiotic therapy was instituted.
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PMID:[Clinical reasoning and decision making in practice. Fever, purpura and hemiparesis in a 29-year old female]. 1247 58

Of a total of 81 patients hospitalized in the infectious diseases department in 1990-2000 with infectious endocarditis caused by Gram-positive pathogen, unusual etiological agents were found in several cases: Streptococcus pyogenes, Streptococcus pneumoniae, Corynebacterium diphtheriae, and Gemella morbillorum. Cardiac defects were present in the latter two patients: bicuspid aortic valve and tetralogy of Fallot. Two patients were successfully treated with antibiotics only and one patient with antibiotics and surgery. The patient with C. diphtheriae endocarditis died due to progressive sepsis and multiple organ failure.
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PMID:Infective endocarditis caused by unusual gram-positive pathogens. 1263 Mar 29

Two cases of meningococcal endocarditis are described. An 84-year-old man developed sepsis and septic shock and died 15 h after admission to the department. The autopsy revealed aortic endocarditis. Blood and vegetation culture yielded Neisseria meningitidis B:16:P1.5. A 37-year-old man was admitted for fever and rash lasting several weeks. Endocarditis of the bicuspid aortic valve caused by N. meningitidis C:2a:P1.2,5 was found. The patient was successfully treated with penicillin G for 4 weeks. Brief epidemiologic characteristics of invasive meningococcal disease in the Czech Republic are given.
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PMID:Infective endocarditis due to Neisseria meningitidis: two case reports. 1461 54


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