Biomedical subjects
Publications and source records attributed to B W Usher.
We have reported the fifth case of endocarditis due to Salmonella enteritidis and the first known survivor of native aortic valve endocarditis from this pathogen. Despite appropriate antibiotic therapy, aortic valve replacement was necessary because of heart failure and embolism. The patient also had concurrent viral hepatitis B infection.
From January 1972 to April 1982, 125 adults underwent operation for congenital heart disease at the Medical University of South Carolina. Age ranged from 18 to 73 years, with an average age of 31 years. A variety of defects were seen. Atrial septal defect (59 patients), ventricular septal defect (15 patients), patent ductus arteriosus (14 patients), tetralogy of Fallot (14 patients), and coarctation of the aorta (9 patients) were the most common. There were 48 men and 77 women in the study. Most patients presented with recent onset of dyspnea on exertion or at rest, but 16 patients were asymptomatic. Eight patients died after surgery for an overall operative mortality rate of 6 per cent. The most common postoperative complication was arrhythmia (13 patients, 10%). Despite recent advances in the diagnosis and treatment of congenital heart disease in infants, a significant number of patients apparently escape detection and first present with congenital heart disease as adults. Prompt diagnosis and surgical intervention will usually produce excellent results and relief of symptoms in these patients.
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During a 36-month period, 14 patients were admitted with endocarditis of the native aortic valve. Echocardiography made a specific contribution to the diagnosis and/or therapeutic management in ten of the 14 (71%). Thirteen patients had aortic valve replacement because of congestive heart failure; only two were stable enough to complete antibiotic therapy prior to operation. There were 12 survivors, all of them alive and clinically improved at nine to 44 months (mean 27 months) of follow-up. There were no instances of recurrent endocarditis. The only medically treated patient died suddenly during the third week of antibiotic therapy. Ten of 14 patients were identified as having valvular vegetations by M-mode or two-dimensional sector echocardiography. Surgical or necropsy corroboration revealed 100% specificity (no false-positive results) and 71% sensitivity of this echocardiographic finding. Aortic valve endocarditis appears to be primarily a surgical disease in which echocardiography plays an important role.
A ten-year-old girl with severe subaortic stenosis was found to have relatively mature valvular endocardial cushion tissue (fibromyxomatous sheets with a chorda tendinea attached to a left ventricular papillary muscle) immediately beneath the aortic valve. This structure behaved like a valve mechanism, obstructing the left ventricular outflow tract during ventricular systole. This anomaly is an extreme on the spectrum of obstructive endocardial cushion malformations.
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The occurrence, diagnosis and treatment of the unreported complication of systemic thromboembolism from a ventricular septal defect patch is described.
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The development of echocardiographically demonstrable vegetations on cardiac valves while the patient is receiving appropriate antibiotic therapy has not been previously reported. We report a case of alpha-hemolytic streptococcal endocarditis involving the aortic valve. Echocardiographically visualized vegetations were noted to occur on the 11th day of hospitalization. We discuss the role of serial echocardiograms in the management of patients with bacteremias and suspected endocarditis but absence of vegetations on the initial echocardiogram.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Two patients who had left coronary artery fistulas that drained into the right ventricle (case 1) and right atrium (case 2) were studied with combined two-dimensional echocardiography and Doppler color flow imaging. The origin of the fistulas from the left coronary artery, their course, and drainage sites were readily identified. These cases illustrate the enhanced identification of left coronary artery fistulas and the drainage sites with the addition of Doppler color flow imaging to two-dimensional echocardiography.
A spontaneous anti-S alloantibody developed without prior transfusion in a 33-year-old male with mixed connective tissue disease. It was detectable by indirect antiglobulin testing using anti-IgG specific, as well as polyspecific anti-human globulin. All previously reported naturally occurring anti-S antibodies had been cold reactive agglutinins, presumably IgMs.