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[A case report of active infectious endocarditis caused by MRSA with chronic renal failure].

A 62-year-old female, who had chronic renal failure treated by HD, was admitted to our hospital with fever. MRSA was identified by blood culture examination. Echocardiography revealed vegetations attached to the mitral valve. Mitral abscess was detected during operation. Mitral valve replacement was performed. We used ECUM and HD for the chronic renal failure during peri- and postoperative days. The postoperative clinical course was uneventful.

Abscess↗

[Infectious endocarditis caused by Q fever].

A case of aortic valve endocarditis caused by Coxiella burnetii and operated on with success is reported. The patient is doing well at 18 months follow up. Diagnosis of Q-fever endocarditis was made by high antibodies against phase I Coxiella burnetii antigens titration and by demonstration of aortic valvular vegetations by bidimensional echocardiography. Our patient suffered emergency aortic valve substitution due to acute hemodynamic failure and started a long-term treatment with doxycycline and rifampicin. Some interesting aspects about the diagnosis and treatment of this patient are reviewed because long-term follow-up and serological controls are still rare in the literature.

Anti-Bacterial Agents↗

[The role of surgery in infectious endocarditis].

161 patients underwent an aortic valve replacement from 1966 till January 1995 for active infective endocarditIS of the native aortic valve. The disease extended to the other cardiac valves in 39 patients and to the surrounding areas in 42 (aortic root and subaortic myocardial tissues). Indications for surgery were: congestive heart failure in 123, uncontrolled sepsis in 44 and emboli in 24. Total follow-up was 1,120 patient-years with a maximum follow-up of 29 years. Early mortality was 8%; late mortality was 3.6%/patient-year; recurrence rate of endocarditis was 1.3%/patient year; survival and reoperation free curve was 68% (S.E. +/- 0.04) at 10 years. These long term results are in favour of a surgical attitude with an acceptable surgical risk without delay.

Adolescent↗

[Aortic valve prosthesis and the plication of a dissecting aneurysm of the ascending aorta in a patient with infectious endocarditis against a background of chronic kidney failure and its management by regular hemodialysis].

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.

Acute Disease↗

[Infectious endocarditis caused by Q fever. Apropos of a clinical case].

Endocarditis is a rare, but some times fatal, complication of Q fever. Its diagnosis is difficult and it is based on non-specific cardiac findings and a high title of phase I antibodies. The treatment is based on tetracyclines alone or in combination with cotrimoxazole, for long periods of time. The therapeutic efficacy is evaluated by the measurement of phase I antibodies, every three months. The relapses are frequent despite the long period of antibiotic therapy. We report what is probably the first case of Q fever prosthesis endocarditis in Portugal, as a complication following an acute episode of Q fever.

Adult↗

[Prophylaxis of infectious endocarditis].

Prophylaxis of infective endocarditis has been the subject of recommendations from most countries for several years. The basis of the recommendations is the administration of prophylactic antibiotics preceding a procedure at risk for patients with a known at risk cardiac disease. The antimicrobial agent is selected to be active against the main microorganisms causing bacteremia according to the type of at risk procedure. Furthermore, the choice and modalities of antibiotic prophylaxis are adapted to take into account a possible documented allergy to penicillin, the type of predisposing cardiac disease, the number of performed procedures and the requirement for general anesthesia. Future advances should concern the diffusion and application of these recommendations, and the appropriateness of these practices in terms of general cost benefit assessment.

Antibiotic Prophylaxis↗

[Echocardiography in infectious endocarditis].

The effectiveness of echocardiography was evaluated in 36 cases of anatomically documented infective endocarditis during the period 1972 to 1976. Valvular vegetations were found in 47% and destructions in 58% of this group. Echocardiography is a valuable tool in the certification of clinically suspected infective endocarditis and in the delineation of a subgroup of patients with valvular vegetations and destruction of aortic and mitral valve leaflets. Echocardiography may therefore play a decisive role in the selection of patients for surgical intervention despite active infection.

Adult↗

[An elderly patient with infectious endocarditis complicated with congestive heart failure due to mitral and tricuspid regurgitation].

A 77-year-old man was referred to our hospital on October 2, 1995 because of fever and left mandibular pain beginning three months before admission. His blood pressure was 90/60 mmHg. A grade III/VI pansystolic murmur was heard over the cardiac apex. The liver was palpable 4 cm below the right costal margin. Lower extremity edema was present bilaterally. White blood cell count was 7,030/mm3 and C-reactive protein was 2.54. Enterococcus faecalis was identified by the blood culture. The diagnosis was infective endocarditis associated with congestive heart failure. He was treated by administration of antibiotics and diuretics. Mitral valve replacement and tricuspid annuloplasty were performed on October 19 because of progressive congestive heart failure with oliguria. The surgical intervention was successful despite the presence of multiple risk factors: high age, emergency, congestive heart failure and active infection. His condition improved dramatically after the operation and he was discharged two months later. Surgical intervention for infective endocarditis was a significant high-risk procedure in this uncontrollable and elderly case. This successful result suggests the indication for the timing of surgery.

Aged↗