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PubMed1989

Annular destruction in acute bacterial endocarditis. Surgical techniques to meet the challenge.

Destruction and disruption of ventricular-aortic or mitral-aortic continuity in the presence of acute infection of the annular tissue is a significant surgical challenge. Among 82 patients who underwent surgical treatment for acute endocarditis over a 10-year period, 15 (18.2%) had extensive destruction of the anulus necessitating special reconstructive techniques for treatment. Surgical treatment involved removal of all infected tissue including annular elements followed by appropriate restoration of the anulus for safe anchoring of the prosthetic valve. The reconstruction of the anulus consisted of the following: a Teflon felt patch inside and outside the aorta or ventricle, or both, for secure attachment of the prosthesis (felt aortic root, in three patients with native valve endocarditis), valved composite graft replacement of the aortic root for ventricular-aortic discontinuity (Bentall procedure, in eight patients with prosthetic valve endocarditis), composite patch reconstruction of the mitral anulus and the ascending aorta to restore mitral-aortic continuity (mitral-aortic composite patch in two patients with mitral-aortic prosthetic valve endocarditis), and direct suture of the sewing skirts of the mitral and aortic prostheses to restore the defect (attached skirts, in one patient with mitral-aortic native valve endocarditis). There was one hospital death caused by multiple organ failure. The most common complication was heart block. Two late deaths were due to reinfection resulting from continued intravenous drug abuse. One patient with a felt aortic root repair required late reoperation for subannular aneurysm. Eleven patients were followed up from 7 months to 66 months and are alive and well without complications. This experience indicates that these seemingly radical surgical techniques can be used in these desperately ill patients with safety and good long-term results. They offer the only lasting solution for major disruption in cardiac anatomy in the presence of infection.

Acute Disease↗
PubMed1989

[A case of two-chambered right ventricle complicating infective endocarditis and tricuspid regurgitation].

A 31-year-old male of two-chambered right ventricle with ventricular septal defect, complicating infective endocarditis and tricuspid regurgitation, was presented. Two-dimensional echocardiographic study demonstrated tricuspid vegetations and a hypertrophied, anomalous muscle bundle in the right ventricle. Cardiac catheterization revealed 58 mmHg pressure gradient between inflow chamber and outflow chamber of the right ventricle. It seems that tricuspid regurgitation was resulted from infective endocarditis. He underwent resection of anomalous muscle bundle, repair of ventricular septal defect, and tricuspid valve replacement with satisfactory result. It has not been reported in Japan so far that tricuspid valve replacement was performed for the treatment of tricuspid regurgitation due to infective endocarditis in the patient with two-chambered right ventricle. In our case, cardiac catheterization was performed after subsidence of infective endocarditis. As echocardiography can detect vegetations and anomalous muscle bundle precisely, surgical intervention would be performed without cardiac catheterization in the case of infective endocarditis intractable to medical therapy.

Adult↗
PubMed1989

Infective endocarditis in a racially mixed community: a 10 year review of 78 cases.

Over a 10 year period, 78 cases of infective endocarditis were seen at a general hospital serving a multiracial community. There was a bimodal distribution by age and by race. Rheumatic heart disease was a predisposing factor in 45% of cases and was particularly common in young Polynesians. Only eight patients had undergone procedures which might have caused bacteraemia. Most cases were due to streptococci (67%) or staphylococci (27%). Eighteen of 78 patients (23%) died in hospital, usually as a result of overwhelming sepsis or neurological complications. The 60 discharged have been followed for an average of almost three years. There have been 11 deaths but only two related to the previous endocarditis. Three of 41 patients infected with viridans streptococci died. There were no relapses and only one microbiological failure due to these organisms. All 14 patients with viridans streptococcal endocarditis treated with combined therapy for two weeks were cured. Ten of 16 cases of Staph aureus endocarditis were fatal. All but one involved the left side of the heart. The series included no intravenous drug abusers. Sixteen cases of endocarditis involved prosthetic valves and in this group the mortality, frequency of complications and need for surgery were significantly more frequent than in those with native valve infection.

Adolescent↗
PubMed1987

[Q fever infectious endocarditis. 3 cases].

An acute infectious disease with predominant pulmonary symptoms, Q fever, may become chronic as hepatitis or, more frequently, endocarditis. We report 3 cases of Q fever endocarditis. In 2 of these patients endocarditis developed on cardiac valve prosthesis. The 3 patients have been under doxycycline for more than a year, and their condition is satisfactory. A review of the literature provides additional data on the epidemiological, aetiological, clinical, biological and therapeutic aspects of this rare type of endocarditis. It is recommended to look for chronic Q fever in all cases of endocarditis with negative blood cultures.

Adult↗
PubMed1986

[Association of bacterial endocarditis and alcoholic cirrhosis in 9 patients].

Ten cases of bacterial endocarditis were observed in cirrhotic patients. In 7 cases, endocarditis was due to group D Streptococcus, 5 of which were Streptococcus D. bovis. Special features were the involvement of tricuspid valve and the involvement of two or more valves in 4 cases. Surgery was necessary in the acute phase in 5 patients: cure was definitely obtained in 8 cases after a particularly long interval. A colonic lesion could have been the portal of entry in some cases. Liver cirrhosis was considered as a predisposing factor for bacterial endocarditis, especially due to group D Streptococcus or to other bacteria of intestinal origin. This is probably related to the frequency of the colonic origin of group D Streptococcus endocarditis. Loss of filter function of the liver may partly explain the features of these forms of endocarditis.

Adult↗
PubMed1987

[Endocarditis and meat inspection in slaughtering pigs. 1. Clinical, pathological and microbiological aspects].

The clinical, pathomorphological and microbiological findings during meat inspection in 599 pigs with endocarditis at slaughter were studied. Clinical signs were observed in 41 per cent of the pigs on ante-mortem inspection. Lameness was the most common sign. However, this symptom is not very specific of endocarditis. This is also true of various other symptoms. Only dyspnoea and drowsiness were indicative of endocarditis to some extent, but occurred only sporadically. Extracardial lesions were observed in 66 per cent of the pigs with endocarditis on post-mortem inspection. Metastatic processes (infarction or inflammatory foci) were most frequently detected in the kidneys. These were highly specific of endocarditis. In addition, the following changes were observed in decreasing incidence: signs of sepsis (hyperplastic splenitis, petechiae and degradation of organs), inflammatory lesions of the joints and legs, metastatic pneumonia and inflammation of the tail. Bacteriological examination was positive in 62 per cent of the cases. Streptococci were the organisms most frequently isolated (36 per cent), followed by Corynebacterium pyogenes (19 per cent) and Erysipelothrix rhusiopathiae (14 per cent). The discussion is concerned with the significance of these bacteria to meat-consumers.

Animals↗
PubMedDate not supplied

Listeria monocytogenes endocarditis: report of a case and review of the literature.

Endocarditis due to Listeria monocytogenes is rare with only 13 cases cited in the world's literature. We report an additional case with a review of the previously reported patients. In contrast to other clinical forms of listeriosis, endocarditis does not tend to occur in patients with severe underlying disorders or those on immunosuppressive regimens. Listeric endocarditis has a predilection for left-sided cardiac involvement (100 percent), and systemic embolization is a major clinical feature (58 percent). Prognosis of listeric endocarditis is unfavorable and the mortality rate (43 percent) exceeds that for bacterial endocarditis with more common pathogens (23 percent). Antibiotic sensitivity data suggest that ampicillin or penicillin may be the chemotherapeutic agents of choice.

Adolescent↗
PubMed1985

[Cardiac complications of infectious endocarditis].

Factors predisposing to cardiac complications and influencing hospital survival, were analysed in a retrospective study of 101 cases of infective endocarditis. Heart failure occurred in 52 p. 100 of our patients. A significantly greater incidence of heart failure was observed in endocarditis with no preexisting heart disease (p less than 0.01), aortic and mitral valve involvement (p less than 0.01), staphylococcus aureus infections (p less than 0.05), arrhythmias (p less than 0.001), and conduction disturbances (p less than 0.01). Significantly more patients with congestive cardiac failure died in hospital (51 p. 100) than those without congestive cardiac failure (17 p. 100) (p less than 0.001). Severe heart failure before treatment (p less than 0.05), streptococcus D endocarditis (p = 0.05), supraventricular arrhythmias (p less than 0.05), and intracardiac conduction disturbances (p less than 0.05), significantly increased the hospital mortality in patients with congestive heart failure. Electrocardiographic findings revealed arrhythmias in 34 p. 100 of cases, more commonly with mitral valve involvement (71 p. 100) and 52 p. 100 died in hospital. The development of intracardiac conduction disturbance during the course of 18 cases of endocarditis (aortic valve in 11 cases) was associated with a hospital mortality rate of 60 p. 100. The incidence of pericarditis and pulmonary embolism was 4 and 7 p. 100 respectively, and all patients died in hospital. Acute inferior myocardial infarction compatible with coronary embolism was suspected in one patient. Early cardiac valve replacement improved the hospital survival in patients with cardiac complications of infective endocarditis.

Adult↗
PubMed1979

[Endocarditis in cancer necropsies (author's transl)].

Terminal endocarditis develope in cancer patients almost latently. There is no difference between the so-called "tumor-endocarditis" and other verrucous endocarditis associated with terminal tuberculosis, sepsis or rheumatism. It is more frequent in cases with large or ulcerated primary tumours and multiple metastases than in cases with early cancer. It also develope more frequently in well differentiated cancer (squamous and adenocarcinoma) than in indifferentiated forms of cancer. Terminal endocarditis is often seen in patients with cancer of the gallbladder, pancreas, liver, stomach, rectum, and ovary. In carcinoma of the liver, pancreas and biliary tract the trend to embolism is more reduced through icterus than the trend to terminal endocarditis.

Adult↗
PubMed1978

[Trombotic endocarditis and its correlation to disseminated intravascular coagulation].

6275 autopsies performed at the Institute of Pathology of the University of Zurich in the period 1973--1976 included 47 microscopically verified cases of thrombotic endocarditis. Thirty of these patients harboured a neoplasm, most often of the gastro-intestinal tract. Twelve died from arterial emboli, particularly to the central nervous system, although valvular disease of the heart was not manifest clinically. The association of thrombotic endocarditis and histologic evidence of disseminated intravascular coagulation was seen in a different group of 30 cases. Patients with carcinomas and thrombotic endocarditis exhibited microthrombi to a significantly higher degree than a comparable control group with carcinomas but without thrombotic endocarditis. There results confirm that hypercoagulability may well be the denominator common to both thrombotic endocarditis and disseminated intravascular coagulation.

Adult↗
PubMed1983

Apparent failures of endocarditis prophylaxis. Analysis of 52 cases submitted to a national registry.

Fifty-two cases of apparent endocarditis prophylaxis failure were reported to a national registry established by the American Heart Association (AHA). Mitral valve prolapse was the single most common underlying cardiac lesion (17 cases, 33%), followed by various congenital abnormalities (15 cases, 29%) and rheumatic heart disease (11 cases, 21%). Ten patients (19%) had prosthetic valve endocarditis. Forty-eight cases (92%) occurred after a dental procedure. Symptoms began within two weeks after the procedure suspected to have caused endocarditis in 50% and within five weeks in 79%. Thirty-nine cases (75%) were caused by viridans streptococci and seven (14%) by Staphylococcus aureus. Most patients received oral penicillin as prophylaxis. Only six patients (12%) received regimens currently recommended by the AHA. In 27 (63%) of the 43 cases for which antimicrobial susceptibility data were available, the infecting microorganism was sensitive to the antibiotic(s) used for prophylaxis. After diagnosis of endocarditis, the prognosis for bacteriologic cure was good; 47 patients (90%) were cured, of whom seven underwent valve replacement. These data indicate that endocarditis prophylaxis failures may be more common than was previously believed and that failures occur even when the infecting organism is susceptible to the antibiotics used. Most antimicrobial regimens used in patients with prophylaxis failures did not conform to current recommendations.

Adolescent↗
PubMed1984

Early valve replacement in active infective endocarditis.

Infective endocarditis is associated with a high mortality, but previous studies have suggested that the major complications of the condition might be prevented by early surgery. Of 50 patients treated for infective endocarditis at the Montreal Heart Institute from 1977 to 1982, 30 were treated nonsurgically and the remaining 20 underwent early valve replacement before preoperative antibiotic therapy was completed. Of these 20, 14 had native valve endocarditis and 6 prosthetic valve endocarditis. The organisms involved were Streptococcus sp in 11, Staphylococcus aureus in 2, gram-negative organisms in 3 and Candida parapsilosis in 1. Blood cultures remained negative in three patients. There were three early deaths (15%) following operation and one late death (5%). Infection on implanted prostheses did not recur, but reoperation was required in one patient because of prosthetic dehiscence 7 months after initial implantation. All resected valves displayed evidence of infection. Follow-up was obtained in all survivors. After an average follow-up of 26 months, 12 patients remained in functional class I and 4 in class II (New York Heart Association classification). Early valve replacement has resulted in improved survival of patients with infective endocarditis and is now associated with a low operative mortality and morbidity.

Adolescent↗
PubMed1984

[Surgical treatment of infective endocarditis in childhood--report of 3 cases].

This is the case report of 3 surgical patients with infective endocarditis in childhood. Case 1: A 8 year-old boy was admitted with high fever and congestive heart failure. Aureus staphylococci were identified by blood culture. Echocardiogram showed a vegetating mass on the posterior mitral leaflet. This patient was cured by emergency mitral valve replacement during the active phase of infection. Case 2: A 3 year-old girl was admitted with infective endocarditis related to VSD. Viridans streptococci were identified by blood culture. Echocardiogram showed a vegetating mass on the septal tricuspid leaflet. After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty. Case 3: A 7 year-old boy was admitted with infective endocarditis related to VSD. Aureus staphylococci were identified with blood culture. Echocardiogram showed a vegetating mass on the anterior tricuspid leaflet and moderate tricuspid regurgitation. After successful antibiotic therapy, this patient underwent the closure of VSD and tricuspid valvuloplasty. We believe that echocardiography plays an important role in the diagnosis and management of infective endocarditis and that tricuspid valvuloplasty is the method of first choice in treatment of the patient with regional tricuspid infective endocarditis.

Child↗
PubMed1981

Cure of Haemophilus parainfluenzae endocarditis with chloramphenicol.

Haemophilus parainfluenzae is an increasingly reported cause of infective endocarditis. In vitro studies have shown this organism to bae almost universally sensitive to chloramphenicol. However, therapy for H parainfluenzae endocarditis with chloramphenicol as a single agent has been disappointing. This has been attributed to the bacteriostatic activity of chloramphenicol, whereas bactericidal agents are essential for cure of infective endocarditis. We successfully treated a patient with H parainfluenzae endocarditis with chloramphenicol alone after in vitro testing showed chloramphenicol to be bactericidal against the organism. When it is documented that chloramphenicol has bactericidal activity against the causative organism, it alone can be effective therapy for H parainfluenzae endocarditis.

Chloramphenicol↗
PubMed1982

Pediatric endocarditis.

Infective endocarditis is a rare disease in the general pediatric population. Nonetheless, children with congenital heart disease have a substantial lifetime risk for development of endocarditis, and recent advances in the management of these children should increase the number of patients who survive infancy and early childhood. During the 30-year period from 1950 through 1979, 50 cases of endocarditis in children were diagnosed at the Mayo Clinic. Of these 50 patients, 37 had congenital heart disease, and 8 were diagnosed as having endocarditis within 3 months after having undergone a cardiac surgical procedure. Nineteen patients died of the disease or its complications. The most common organism isolated at Staphylococcus aureus (19 patients), followed by viridans streptococci (14 patients). Children younger than 10 years of age experienced a particularly high mortality, as did patients of all ages with S. aureus infection. Any unexplained fever in a child with congenital heart disease deserves close investigation; if endocarditis is suspected, early empiric antibiotic therapy is indicated after appropriate culture specimens have been obtained. Moreover, localized bacterial infections in children at risk must be treated aggressively to prevent metastatic spread to the heart.

Adolescent↗
PubMed1982

Imaging endocarditis with Tc-99m-labeled antibody--an experimental study: concise communication.

The sensitivity and specificity of Tc-99m-labeled antibacterial antibody (Tc-99m Ab) for detecting bacterial endocarditis were evaluated in an experimental model. Rabbit-produced antistaphylococcal antibody was extracted using Rivanol and chemically labeled with Tc-99m. This Tc-99m Ab was injected intravenously in New Zealand rabbits 24 hr after producing Staphylococcus aureus endocarditis of the aortic valve. Imaging and tissue analyses were performed on the following day. All 11 animals developed S. aureus aortic-valve vegetations and showed increased uptake of Tc-99m Ab at the aortic valve, 118 times higher than at the uninfected tricuspid valve. Although high hepatic radioactivity and anatomic uncertainties interfered with in vivo delineation of these lesions, images of the excised hearts showed all affected valves. Two rabbits inoculated with Escherichia coli did not develop endocarditis and had little uptake of Tc-99m Ab, while six rabbits with enterococcal endocarditis had no uptake of the Tc-99m Ab in their vegetations. The findings suggest potential value of Tc-99m Ab on the rapid diagnosis of endocarditis.

Animals↗
PubMed1982

Prosthetic valve endocarditis.

Prosthetic valve endocarditis is an infrequent but serious complication of cardiac valve replacement. The overall frequency of prosthetic valve endocarditis is approximately 2%. The frequency of early-onset and late-onset infections is 0.78% and 1.1%, respectively. Staphylococci are the most common isolate from patients with early-onset infection, accounting for 47.5% of the total number of isolates. Staphylococcus epidermidis causes 27% of these staphylococcal infections. Among patients with late-onset infection, streptococci are the predominant microorganism, constituting 42% of the total number of isolates from patients in this group. The overall mortality among patients with prosthetic valve endocarditis is high--59%; the mortality among patients with early- or late-onset infections is 77% and 46%, respectively. Most patients with staphylococcal prosthetic valve endocarditis should undergo cardiac valve replacement in addition to antimicrobial therapy. Closely monitored anticoagulant therapy should be cautiously continued in patients with prosthetic valve endocarditis.

Anti-Bacterial Agents↗
PubMed1982

[Bacterial endocarditis : lack of diagnostic value of immunological investigations (author's transl)].

To evaluate the diagnostic help afforded by immune determinations in feverish valvular patients, we prospectively determined: total hemolytic complement, cryoglobulin, rheumatoid factor, circulating immune complexes and direct skin immunofluorescence. Twenty patients entered the study, twelve with bacterial endocarditis, six without any bacteremia and two septicemic patients without endocarditis. We detected at least one immune abnormality in 10/12 endocarditis patients: - in 7/11 (64 p. cent) circulating immune complexes; - in 3/12 rheumatoid factor; - in 3/12 positive fluorescence in dermal vessels (IgM-C3); - and in one patient an IgG lupus-like band in the membrane basal zone. We also found circulating immune complexes in 3/4 patients without bacteremia and in 1/2 septicemic patients. We conclude that, in our small prospective study, immune abnormalities are frequent in bacterial endocarditis patients but their diagnostic values is rather limited : their absence do not rule out endocarditis and they can be present in many other febrile disorders.

Adult↗