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PubMed1998

[Epidemiology of infectious endocarditis].

The incidence of infective endocarditis (20 to 160 cases per million inhabitants yearly) increases with age; it does not seem to be decreasing over time. There is no previously known heart disease in 30% of the patients, a native valve disease in 30 to 60%, a prosthetic valve in 15-20%. Streptococci remain the leading microorganisms. Digestive streptococci and staphylococci are increasing. Iatrogenic portals of entry are in progression. During the hospital stay, case fatality ratio varies from 13 to 20%. After endocarditis, the patient remains at risk of late cardiac surgery and of recurrence. Survival after 5 years is approximately 85%.

Age Factors↗
PubMed1998

[The contribution of experimental models to the physiopathology and treatment of infectious endocarditis].

The model of experimental endocarditis can be used for the investigation of the different steps in the physiopathologic process leading to the formation of the infected cardiac vegetation. It has also greatly contributed to the knowledge of the characteristics of the infected vegetation. These data allow a better understanding of the therapeutic consequences (both preventive and curative) of the physiopathologic process.

Animals↗
PubMed1998

[Diagnostic criteria of infectious endocarditis].

Accurate diagnostic criteria for infective endocarditis are essential to epidemiological studies. The von Reyn's criteria have been widely used for more than a decade after they were published in 1981. In 1994, the Duke's criteria for the clinical diagnosis of infective endocarditis were published, incorporating echocardiographic findings. They are modeled after the Jones criteria for the identification of cases of rheumatic fever and include 2 major and 6 minor diagnostic criteria. They are about twice as specific as the former von Reyn's criteria, without loss of specificity, and should become a standard reference for diagnosing infective endocarditis.

Bacteremia↗
PubMed1998

[The microbiology of infectious endocarditis].

If streptococci and staphylococci remain the main bacteria responsible for infective endocarditis (80%), the emergence of Streptococcus bovis associated with intestinal lesions, the confirmation of the role of Coxiella burnetii, and the discovery of the responsibility of Bartonella sp in case of negative blood culture endocarditis have been the principal microbiological modifications during the last few years. Blood cultures performed under the best technical conditions and the examination and culture of the valve after surgery remain the better means for diagnosing infective endocarditis. In case of negative blood culture (11% of the infective endocarditis), the serologic tests against C. burnetii and Bartonella should decrease the rate of diagnostic uncertainty. The development of bacteriological techniques, particularly molecular methods, should improve the microbiology of infective endocarditis lead to the discovery new aetiological agents.

Bacteremia↗
PubMed1998

[Cardiac ultrasonography in the diagnosis and monitoring of infectious endocarditis].

Transthoracic and transoesophageal doppler echocardiography has become an essential tool for the diagnosis of infective endocarditis. It detects valvular vegetations and destructions, evaluates regurgitations, and appreciates haemodynamic tolerance. Recognition of endocarditis, early identification of high-risk patients, and detection of mechanical complications are the most accurate informations derived from this technique. Transoesophageal echocardiography has the potential to avoid the difficulties encountered using the transthoracic approach, and it must be used particularly in the presence of non diagnostic transthoracic examination when clinical suspicion is high.

Echocardiography, Doppler↗
PubMed1998

[Methods and monitoring of antibiotic therapy of infectious endocarditis].

Antibiotic treatment of infective endocarditis has to be discussed when the microorganism has been identified. Antibiotics must be started as soon as possible, just after blood samplings in case of clinical bacteraemia, or as soon as blood cultures are positive. In case of negative blood cultures, diagnosis of endocarditis has to be reconsidered, according to Duke's criteria, and antibiotics must not be started until there is strong evidence in favour of infective endocarditis. Antibiotic treatment must be bactericidal, intravenously administered, for a long time to sterilize vegetations. Duration of antibiotics depends on the microorganism, and whether there is a valvular prosthesis or not. Hospitalization is often mandatory, but there is a trend towards the use of outpatient treatments, only possible in some indications.

Anti-Bacterial Agents↗
PubMed1998

[Surgery of infectious endocarditis].

Thirty to fifty percent of patients with infective endocarditis are operated on during the active phase of the disease; this percentage is higher in case of some valvular localizations (aortic), in case of early prosthetic valve endocarditis, in case of some microorganisms (Staphylococcus aureus, gram-negative, fungus, intracellular microorganism). Operative death (at 30 days) is below 10% in native valve endocarditis, close to 50% in early prosthetic valve endocarditis, and below 20% in late prosthetic valve endocarditis. When active infective disease has been healed by medical treatment alone, half the patients need surgery in the first 2 years of follow-up; the indications for surgery are the functional status, the degree of valvular leaks and other lesions, the degree of ventricular dilatation.

Aortic Valve↗
PubMedDate not supplied

[The echocardiographic aspects of infectious endocarditis].

Infective endocarditis is a severe disease observed frequently in cardiologic centers. The importance of echocardiography in the diagnosis, the morphological criteria of vegetations, abscesses and periaortic complications were analyzed. The use of transesophageal echocardiography in patients with surgical indication is assessed. The significance of clinical symptoms of infective endocarditis in the echocardiographic interpretation must be always taken into consideration.

Abscess↗
PubMedDate not supplied

[Mitral and/or aortic infectious endocarditis. The correlation between transesophageal echocardiography, surgery and pathological anatomy].

The aim of this study was to correlate the findings obtained by transesophageal echocardiography (TEE) with those obtained during surgery and histopathologic studies in patients with mitral and/or aortic infective endocarditis. Twenty eight patients were studied. In all of them clinical history, bacteriological study and TEE. In 15 cases a positive blood culture was found and in 13 the blood culture was negative. The TEE demonstrate infective aortic vegetations in 12 cases, in mitral valve in 11 and in five in both valves. The endocarditis-associated complications were found in 53% of cases and the incidence of embolic events was of 25%. TEE findings related with the presence of vegetations were confirmed in the studies of pathologic anatomy in 92.8% and at surgery in 89.2%. These data suggest that the TEE leads to a significant improvement in the diagnosis and prognosis of mitral and/or aortic infective endocarditis, because it has a high correlation with the studies of pathologic anatomy and surgery.

Abscess↗
PubMedDate not supplied

[The neurological complications of infectious endocarditis].

We review the neurologic complications of 131 episodes of infective endocarditis, and the influences of some factors that are considered risk factors at its presentation, like the presence of vegetations detected by echocardiography, type and location of involved valve, or bacterial culture. Neurologic complications occurred in 28 patients (21.4%), 4 of them were excluded because of the absence of neuroimaging studies. In 21 patients the underlying cardiac pathology was valve disease and in the remaining 3 patients was congenital heart disease. 11 patients had native valve endocarditis and 10 prosthetic valve endocarditis. The cultured bacteria were Streptococcus viridans in 8 cases and Staphylococcus aureus in 7. The most frequent complication was cerebrovascular with incidence of cerebral embolism, and intracerebral hemorrhage of 62.5% and 8.3% respectively. Echocardiographic evidence of vegetation was seen in 18 patients, and cerebral embolism were noted in 12. Death occurred in 29% of patients with neurologic complications and 27% without. Two of nine patients who underwent open-heat surgery died. We conclude that there is no difference in the incidence of neurologic complications between mitral and aortic valve groups, neither when comparing native and prosthetic valve groups. Open-heart surgery does not increase mortality in this group of patients.

Adolescent↗
PubMed1998

[The current potentials and the role of echocardiography in the diagnosis and surgical treatment of infectious endocarditis].

The authors have analyzed results of examination of 107 patients with infective endocarditis (IE) of the natural (IENV) and artificial valves (IEAV) of the heart. It was found that the revealed ultrasonic symptoms of IE were specific in 97.7% of patients with IENV and in 100% of patients with IEAV. The sensitivity of transthoracal echocardiography was 89.6% in patients with IENV and 65% in patients with IEAV. The intracardiac morphological alterations were found to coincide with the findings of echocardiography in 78.2% of patients with IENV and in 55%--with IEAV. The authors have elaborated an algorithm of the complex diagnostic examination of patients.

Adolescent↗
PubMed1998

[Aortic peri-valvular abscess, mycotic aneurysm of Valsalva sinus, and fistula to the right ventricle in a context of acute infectious endocarditis].

Infective endocarditis continues to attract the attention of many physicians. The authors present a case report of a 64 year old man with a history of infective endocarditis of a native aortic valve complicated by a perivalvular abscess, mycotic aneurysm of a sinus of valsalva and acquired aorta-right ventricular shunt.

Aneurysm, Infected↗
PubMed1998

[Epidemiological changes in infectious endocarditis. A prospective study, 1992-96].

BACKGROUND: To know the present epidemiological situation of the infective endocarditis in our environment and its evolution in the last few years. RESULTS: The incidence of infective endocarditis was 0.85 per thousand patients admitted to hospital, with a mean age of 43 years. The predisposed factors more frequently found were: drug addiction (32%) and cardiac prosthetic valves (23%). In the greatest number of our patients the cardiac valves involved were: tricuspid (28%), mitral (27%) and prosthetic valves (23%). The causative organism were: S. aureus (19 cases), Streptococcus (15 cases) and S. epidermidis (11 cases). The echocardiography study resulted diagnostic in 90% of the patients, valve replacements were performed in 22% of the cases. The overall mortality rate was 10%. CONCLUSIONS: The current profile of infective endocarditis is characterized by a high incidence of parenterally drug addict patients or prosthetic valves carriers. Increase of the infections of S aureus and a decrease of Streptococcus infections, as well as a less overall mortality.

Adolescent↗