Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “ENDOCARDITIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 631 records · Page 35Linked to original sources
PubMed1994

The Ross operation in the treatment of native and prosthetic aortic valve endocarditis.

Bacterial endocarditis of the native or prosthetic aortic valve is associated with significant morbidity and mortality despite aggressive medical and surgical treatment, especially when invasion of perivalvular tissue occurs. The currently recommended treatment for these advanced infections, in addition to thorough debridement, is aortic valve or root replacement with a homograft, although it appears that equally good results can be achieved with prosthetic valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of non-infective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. This paper describes successful use of the Ross operation as total root replacement in six young patients between 10 and 32 years of age with aortic valve endocarditis. Three of the patients had active endocarditis and five patients had advanced disease, i.e. endocarditis with perivalvular tissue invasion and destruction. Follow up extending to 18 months continues to show excellent results with no mortality and no re-infection. We conclude that the Ross operation as total root replacement may be the best procedure for young patients with aortic valve endocarditis. The pulmonary autograft appears to be technically particularly well-suited, has growth potential, excellent hemodynamics, and a low risk of re-infection, thrombosis, and embolic complications without anticoagulation. Based on the long term results of the Ross operation in non-infected patients, excellent long term results are expected in this group as well.

Adolescent↗
PubMed1994

[Clinical aspects and diagnosis of infectious endocarditis].

The first step in the diagnosis of infective endocarditis is a high level of clinical suspicion. Only rarely are all the classic signs of infective endocarditis, namely fever, a new cardiac murmur, splenomegaly, anemia and embolic phenomena, found. Every organ system can be involved by embolic or immunologic complications. We have to look specially for manifestations in skin and mucosa, CNS, kidney, locomotor system and lungs. The clinical spectrum has changed over the last decades. More elderly patients, patients with prosthetic heart valves and i.v. drug users are affected. The traditional classification into acute and subacute infective endocarditis has been replaced by a classification based on the microbiological etiology or on the involved valve (native, prosthetic, left- or right sided). In particular, the clinical presentation of right-sided infective endocarditis differs from the left-sided one. A diagnosis of infective endocarditis has to be considered in every patient with unexplained fever or a multisystem disease. A definite diagnosis of infective endocarditis rests on a multidisciplinary approach that involves the clinician and the echocardiography and microbiology laboratories.

Adult↗
PubMed1994

[Infectious endocarditis and congenital heart defects in adults].

BACKGROUND: Infective endocarditis still remains a cardiological menace. However, the type of predisposing diseases has changed: the incidence of rheumatic heart disease in advanced countries has declined, advances made in the surgical and medicamentous treatment of inborn heart disease are the reasons why we are encountering, with increasing frequency, infective endocarditis which develops on their background. METHODS AND RESULTS: The objective of the investigation was to assess the frequency of infective endocarditis and predisposing diseases. During the time interval between 1987 and 1991 16 patients (50% younger than 50 years) were hospitalized with the diagnosis of infective endocarditis. Rheumatic valvular damage and inborn heart disease were the predisposing factor in 25%. All patients were younger than 30 years (mean 24, range 18-30), and half the patients suffered from defects of the ventricular septum. Other defects were tetralogy of Fallot and inborn aortic stenosis. In 10% of the patients infective endocarditis developed on the background of a mitral valve prolapse with regurgitation. Echocardiographic examination confirmed the diagnosis in almost 70% by revealing vegetation. Bacteriological examination revealed the agent in 60%, most frequently it was Streptococcus viridans. The mortality rate in the group was 13%. CONCLUSIONS: The recorded incidence of infective endocarditis, 1.5 pro mille, is consistent with data in the literature. Corrected and not corrected heart disease plays an important role as predisposing disease. Despite the opportunity of intensive antibiotic treatment, the mortality remains high--13%.

Adolescent↗
PubMed1993

[Cardiac lesions in bacterial endocarditis: from findings of pathology to possibilities and limits of surgery].

Infective endocarditis remains a common condition for pathologists interested in cardiology who fortunately examine more infected valves excised surgically (66 in 1992) than observed at autopsy after death from this condition (2 in 1992). The authors discuss the elementary valvular lesions (ulceration and vegetations), the severity of which affects the prognosis, and the special aspects of these ulcerating vegetations with respect to their location (aortic, mitral, pulmonary and tricuspid), to the type of underlying valvular disease (rheumatic, myxoid or calcific) and infecting organism. The extravalvular complications are then reviewed: annular abscess (and possible extensions), purulent pericarditis, parietal endocarditis, myocarditis and coronary embolism. The authors attempt to answer questions about infective endocarditis from the pathologist's viewpoint: the difference between acute and subacute endocarditis, the reality of infective lesions of "healthy hearts", the role of the pathologist in the detection of pathogenic organisms, the evolution of lesions after sterilisation. The particular situation of prosthetic valve (biological or mechanical) endocarditis is treated in detail. The role and possibilities of surgery, the value of which is now universally accepted (the mortality of severe infective endocarditis has been lowered from 50-60% to 10-20% by a good operative strategy) are emphasised throughout.

Abscess↗
PubMed1993

[Surgery for bacterial endocarditis. When?].

In 1993, infectious endocarditis (IE) remains a common and serious condition. Surgery has become an essential feature of treatment in many cases. The choice and optimal timing depend on many factors: the tolerance of the underlying cardiac disease is an important feature, surgery being indicated not only in cases of necessity (refractory cardiac failure) but also as treatment of choice in cases of episodic decompensation even if temporary when related to valvular dysfunction. In these conditions, if the lesion is severe aortic incompetence, surgery can be programmed in two or three weeks after initiating antibiotic therapy; the bacteriological indications are less common: fungal endocarditis, prosthetic valve endocarditis due to gram-negative bacilli or staphylococcus aureus endocarditis, or IE on native valves with persistent signs of sepsis after one week of antibiotic therapy; the occurrence of some complications may require urgent surgery: high degree atrioventricular block, septal perforation, ring or perivalvular abscess detected at echocardiography, single or multiple systemic embolism with persistence of large, mobile vegetations at echocardiography. Conversely, tricuspid valve endocarditis usually respond well to medical treatment alone: surgery (valvuloplasty with excision of vegetations, valvulectomy or, preferably, bioprosthetic valve replacement) is sometimes indicated in septic states related to certain pathogenic organisms. The operative indications in 1993 have become more extensive and earlier: analysis of surgical results shows that operative mortality depends mainly on the haemodynamic status at the time of operation, but also on the severity of the anatomical lesions, the nature of surgery, the type of endocarditis, native or prosthetic valve, and the causal organism.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMed1993

[Surgery in acute bacterial endocarditis. Restraints--possibilities].

The limitations and possibilities of surgery in acute infective endocarditis depend on the indication, haemodynamic or bacteriological, the site of infection, aortic or mitral, and whether affecting a native or prosthetic valve. The common possibility of conserving the mitral valve in acute endocarditis is an additional therapeutic option. Similarly, the use of aortic homografts has improved the results in aortic endocarditis. Surgical principles have therefore evolved with conservative mitral valve surgery and "biological" aortic valve replacement. Techniques in prosthetic valve endocarditis have not surgery and earlier extra-anatomical procedures to avoid multiple recurrence with use of homografts or Danielson's technique for the aortic orifice. There have been fewer innovations for recurrent endocarditis on mitral valve prostheses. Irrespective of the site or type of endocarditis, the precocity of surgical treatment is an essential prognostic factor.

Acute Disease↗
PubMed1993

[Situations and procedures with risk of bacterial endocarditis (intracardiac surgery excluded)].

Situations which can be considered at risk for infective endocarditis are those causing a bacteremia, which is necessary for the development of an endocarditis. Such situations can be identified by clinical studies evaluating the rate at which a bacteremia occurs after some procedures or because of lesions, then the risk of endocarditis after such a bacteremia. Without considering preexisting cardiac lesion and age, some situations seem to be at risk of subsequent endocarditis: acute bacterial infection for which antibiotherapy is necessary; procedures involving the mouth with the exception of superficial caries and bloodless supragingival prosthetic preparations; oesophageal dilatation, laser endo-oesophageal procedures, sclerosis of oesophageal varices; colonoscopy and sigmoidoscopy for cancer lesions, gastrointestinal procedures on a potentially infected gastrointestinal tract (cholecystectomy, colectomy...); tonsillectomy and adenoidectomy; naso-tracheal intubation; instrumental procedures involving the ureter or kidney, and prostatic or urinary tract biopsies and surgery; procedures performed on infected skin. In cardiac patients at high risk, in addition to the above retrograde cholangiography, colonoscopy and rectosigmoidoscopy, lithotripsy. In these situations the risk of endocarditis is probably linked to the rate of bacteremia, the size of inoculum, and the bacteria, compared with spontaneous bacteremia without any procedure, where the inoculum is low and bacteria is considered as non pathogenic. A prophylaxis has to be discussed in such situations, which are probably involved in less than 10% of endocarditis.

Adenoidectomy↗
PubMedDate not supplied

Haemophilus parainfluenzae endocarditis in a patient with mitral valve prolapse.

Haemophilus parainfluenzae is a frequent cause of "culture-negative" endocarditis (i.e., endocarditis owing to a fastidious organism which may require longer incubation periods and/or enrichment media for detection compared to traditional pathogens). More cases will probably be identified with improvements in growth and isolation techniques. A case of H. parainfluenzae endocarditis is presented in a patient with mitral valve prolapse, which illustrates the difficulty in diagnosing endocarditis when initial blood cultures are negative. Particularly, it emphasizes the difficulty in selecting appropriate antibiotic therapy since beta-lactamase producing organisms are being isolated with increased frequency. This report is unique in that it documents successful treatment with a cephalosporin and what is, to our knowledge, the third reported case of a beta-lactamase producing H. parainfluenzae causing endocarditis. The authors believe that beta-lactamase stable second or third generation cephalosporins should constitute initial treatment of H. parainfluenzae endocarditis until sensitivity studies become available, since beta-lactamase production by this organism would nullify the effect of the previous agent of choice, ampicillin.

Adult↗
PubMed1993

[Right endocarditis caused by Staphylococcus aureus in parenteral drug addicts: evaluation of a combined therapeutic scheme for 2 weeks versus conventional treatment].

BACKGROUND: Intravenous drug addicts (IVDA) are a group of patients in whom it is difficult to complete standard treatment of infectious endocarditis due to frequent antisocial behavior and in whom, once clinical improvement is achieved, voluntary discharge is frequently requested. This is why the evaluation of new treatment schedules tending to decrease the length of the same is of great interest. This non randomized study has the aim of knowing the efficacy of a short treatment with cloxacillin or vancomycin associated to gentamicin in right-sided endocarditis by methicillin-sensitive Staphylococcus aureus, comparing this with the standard schedule of 28 days. METHODS: This series was made up of IVDA patients diagnosed of right endocarditis by S. aureus. Inclusion criteria were the presence of intravenous drug addiction, isolation of methicillin-sensitive S. aureus in 2 or more blood cultures and achievement of the diagnostic criteria of right-sided endocarditis. Two schedules were used: a) standard: cloxacillin or vancomycin for 4 weeks, associating aminoglucoside in the first 3-5 days; b) short; cloxacillin or vancomycin associated to gentamicin for 2 weeks with no ulterior treatment. The study was not randomized and the treatment of 2 weeks was compared with historic controls treated for 4 weeks. The criteria evaluated were those of clinical cure, relapse, appearance of complications during treatment and mortality. RESULTS: Both the standard treatment and the combination of cloxacillin or vancomycin with gentamicin for 2 weeks cured 100% of the episodes of right endocarditis by S. aureus. There were no relapses and mortality was nul. Neither were there any differences between the two groups with regard to appearance of complications. CONCLUSIONS: In intravenous drug addict patients with right-sided endocarditis by methicillin S. aureus, the association of cloxacillin and gentamicin for 2 weeks is an effective alternative to long (4 week) treatments with only one antibiotic. The low number of cases treated with vancomycin does not allow conclusions to be drawn on its efficacy.

Adult↗
PubMed1993

Zoonotic endocarditis.

The so-called zoonotic endocarditis is transmitted from animals to humans and is frequently found in some cattle-raising countries. Brucella endocarditis is a destructive process of the aortic valve with abscess formation that commonly leads to heart failure. Q fever endocarditis is a more indolent infection, but it is also capable of producing severe valvular damage and hemodynamic compromise. Treatment of zoonotic endocarditis includes the prolonged administration of doxycycline in combination with other antimicrobial agents and a judicious use of valve replacement. Mortality of Brucella endocarditis has been decreased significantly by a medical-surgical approach to treatment. On the basis of serologic and valve tissue culture results, no treatment is consistently able to cure Q fever endocarditis, and thus mortality of this infection remains high.

Animals↗
PubMedDate not supplied

The "incubation period" of subacute bacterial endocarditis.

In an attempt to gain information about the "incubation period" of subacute bacterial endocarditis, the literature was searched for case reports stating a specific interval between an event likely to cause bacteremia and the onset of symptoms. In 76 cases of streptococcal endocarditis for which this information was given, the median "incubation period" was one week. Symptoms began within two weeks in 64 of these cases (84%). Although there may be a bias toward reporting short incubation periods, it is concluded that the incubation period of subacute bacterial endocarditis is often shorter than is generally realized, and that procedures carried out more than two weeks before onset of symptoms are less likely to be causally related. In postcardiotomy cases, where timing of the bacteremia causing endocarditis is less easy to define, 27% of 122 cases of staphylococcal endocarditis developed within two weeks of surgery. This information is relevant to the planning and evaluation of prophylactic chemotherapy against bacterial endocarditis.

Cardiac Surgical Procedures↗
PubMed1995

[Native valve endocarditis caused by Staphylococcus aureus and streptococci. A comparative study].

OBJECTIVE: To know the validity and current prognosis of clinical prototypes assigned to streptococcal endocarditis (STREPEND) and Staphylococcus aureus endocarditis (SAE). PATIENTS AND METHODS: Fifty-four patients with SAE were compared with 43 patients with STREPEND diagnosed from 1984 to 1994 following a retrospective cohort study model. RESULTS: The incidence of SAE and STREPEND was 0.21 and 0.17, respectively, per 1,000 hospital admissions. The acquisition of community endocarditis (non drug abusers vs. drug abusers) and nosocomial endocarditis was 74% (31% vs. 43%) and 26% for SAE; the corresponding values for STREPEND: 89% (70% vs. 19%) and 11%, respectively. The overall mortality rate for STREPEND/SAE was 9%/26% (among drug abusers there were no fatalities recorded), whereas in non drug abusers the mortality rate reached 41% and for nosocomial forms 36%. SAE was independently associated with drug abuse habits, right-sided heart infection, development of embolism and a high mortality rate. In contrast, by means of the multivariant analysis, STREPEND was independently associated with a subacute onset form, left-sided heart infection, cardiac surgery, and a low mortality rate. CONCLUSIONS: Traditional stereotypes of the two main etiologies for endocarditis are still valid, although at present it is important to differentiate nosocomial endocarditis and in non drug abusers. Chemoprophylaxis compliance is low for STREPEND: Given the poor prognosis of SAE at the left heart side a more aggressive surgical attitude would be warranted.

Adult↗
PubMed1995

Diagnostic value of transesophageal compared with transthoracic echocardiography in suspected prosthetic valve endocarditis.

To compare transthoracic (TTE) and transesophageal (TEE) echocardiography specifically in prosthetic valve endocarditis, 73 consecutive patients (age, 7 to 80 years) with 86 prostheses who had TTE and TEE for suspected endocarditis were analyzed retrospectively. Thirty-four patients proved to have endocarditis according to clinical criteria (pathoanatomical confirmation in 16), the remaining 39 served as controls. In the endocarditis group, a total of 38 (25 mitral, 13 aortic) prostheses were investigated. Vegetations were detected by TTE in 5 (all aortic) and TEE in 28 (20 mitral, 8 aortic) prostheses (13 vs 74%, p < 0.0001). An annular abscess was found on TEE in 1 mitral implant (3%). New perivalvular regurgitation was demonstrated on TTE in 7 (2 mitral, 5 aortic) and on TEE in 16 (10 mitral, 6 aortic) prostheses (18 vs 42%, p = 0.025). All in all, abnormalities suggestive of endocarditis were revealed on TTE in 10 (2 mitral, 8 aortic) and on TEE in 35 (23 mitral, 12 aortic) prostheses (sensitivity 26 and 92%, p < 0.0001). In the control group, TEE was false positive in 1 mitral prosthesis (specificity for TTE and TEE 100 and 97%, respectively; p = NS). These results indicate that TEE is markedly superior to TTE in prosthetic valve endocarditis. The diagnostic advantage is most evident in mitral prostheses. This holds for the detection of both morphologic changes and prosthetic malfunction.

Abscess↗
PubMed1996

Endocarditis in injection drug users.

Injection drug use is an important risk factor for endocarditis. The clinical manifestations of endocarditis associated with injection drug use differ from those in person who do not use drugs. Endocarditis in drug users more often affects the right side of the heart and presents with fever and pulmonary emboli rather than left-sided emboli. Blood cultures and echocardiography are the mainstay of diagnosis; these tests are particularly helpful in identification of endocarditis associated with injection drug use because of the high frequency of right-sided valvular involvement and the low incidence of culture-negative endocarditis in this population. Since staphylococcal species are the dominant causative organism, penicillin and an aminoglycoside are the treatments of choice. Injection drug users with left-sided endocarditis or with symptomatic human immunodeficiency virus infection have poor prognoses.

Anti-Bacterial Agents↗
PubMed1997

The use of mechanical prostheses in native aortic valve endocarditis.

BACKGROUND AND AIMS OF THE STUDY: The optimal aortic valve substitute in cases of active native valve endocarditis (NVE) remains controversial. This report summarizes our experience with the surgical treatment of active aortic NVE using only mechanical prostheses. METHODS: Between January 1988 and January 1996, 20 patients underwent aortic valve replacement for active NVE. There were 17 men and three women. Mean age was 46.5 years (range eight to 63 years). Thirteen patients were in NYHA class IV and seven in class V. Streptococci were isolated in eight cases, while no causative micro-organism could be identified in seven patients. All operations were performed on urgent (n = 13) or emergency (n = 7) bases. A mechanical valve was implanted in all cases and radical resection of the infected tissues performed using different techniques. All patients were followed up at our institution. Two-dimensional color Doppler studies were performed one month after surgery and at six-month intervals after the first year. Transesophageal echocardiography (TEE) was performed at discharge, six months after surgery and yearly thereafter. RESULTS: No patient died in hospital. Mean follow up was 30.5 months, during which time three patients died, though none from endocarditis-related causes. Endocarditis recurred only one (5%). TEE demonstrated a normally functioning aortic prosthesis in 15 cases and trivial paravalvular leakage in two. CONCLUSIONS: Mechanical prostheses represent a safe aortic valve substitute in cases of acute native valve endocarditis. When radical resection of all the infected areas is performed, the incidence of endocarditis recurrence is acceptable. The concept that homografts are the valve substitute of choice in endocarditis cases cannot be supported by this study.

Adolescent↗
PubMed1997

[Concealed infective endocarditis].

The occurrence of concealed infection or "natural remission" in infective endocarditis was investigated microscopically in 35 consecutive patients (36 valves) with infective endocarditis (between April 1987 and May 1995). Four patients were considered as having concealed or silent infective endocarditis. Preoperative diagnosis of these patients was mitral valve prolapse, rheumatic aortic valve stenosis with insufficiency, aortic valve prolapse and hypertrophic cardiomyopathy, respectively. These patients did not present with any clinical signs of infective endocarditis such as cardiac murmur and ventricular dysfunction. Histological examination of the excised valves revealed valvular perforation, small round cell infiltration, neovascularization, remnants of vascular smooth muscle cells, and organizing vegetations. These findings are consistent with the histological findings of infective endocarditis. Latent infective endocarditis may be present without inflammatory manifestation.

Aortic Valve Insufficiency↗
PubMed1997

[Endocarditis caused by group B streptococci in adults].

OBJECTIVE: To evaluate clinical characteristics, treatment and outcome of group B streptococcal endocarditis in nonpregnant adults. METHODS: We included all cases of Streptococcus agalactiae endocarditis diagnosed according to the Duke criteria between 1980 and 1994 in a 1000-bed university hospital, where a prospective surveillance of all cases of bacteremia is regularly performed. RESULTS: There were 9 episodes of S. agalactiae endocarditis, that account for the 10.5% of 85 bacteremia caused by this organism and 2.6% of 336 infectious endocarditis (in non-drug abusers) during the study period. They occurred in 6 males and 3 females with an average age of 60 years (44-86 years). Three patients had underlying disease and three had been previously diagnosed of having valvulopathy. There were no cases of prosthetic valve endocarditis. The valves most frequently involved were the aortic and mitral valves. Only one patient had large vessel embolization. All isolates were penicillin-susceptible (MIC < 0.12 microgram/ml). Most of the patients were treated with penicillin plus an aminoglycoside and 6 patients also underwent surgery combined with the medical therapy after an average of 40 days (13-60 days). The overall mortality was 11%. CONCLUSIONS: S. agalactiae is a rare cause of infectious endocarditis. Combination of surgery with the antibiotic therapy might decrease mortality rates of this infection.

Adult↗
PubMed1997

Diagnostic value of echocardiography in infective endocarditis: a probabilistic approach.

The high sensitivity and specificity of echocardiography in the diagnosis of infective endocarditis have been well established for a number of years. However, little is known yet about the incremental value of this technique over the clinical and serological findings already available in subsets of patients presenting different initial probabilities in infective endocarditis. In this report, sensitivity and specificity of echocardiography were calculated in 173 consecutive patients with suspected infective endocarditis who underwent echocardiography within 5 days following admission. The echocardiogram was considered positive when Duke major criteria were fulfilled. Infective endocarditis was diagnosed in 88 patients, while other illnesses in the remaining 85. The diagnoses were confirmed retrospectively with a follow-up done after at least 3 months, at surgery or during autopsy. Sensitivity and specificity of the echocardiography in this population were 85 and 97% respectively. The initial probabilities of infective endocarditis in patients with different clinical presentations were taken from a thorough review of the literature available in English and from personal research. The positive predictive value of echocardiography is already high or very high even at low or very low levels of initial probability, and this has a strong impact on clinical decisions. In these situations and with intermediate probabilities, a negative echocardiogram would theoretically rule out the disease. However, this result, if considered alone, calls for a careful reassessment of the entire clinical context. As with any other test, when the initial probabilities of infective endocarditis are highest, the incremental value of echocardiography is poor.

Adolescent↗