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PubMed2005

[Indication for surgical intervention and surgical approach to complicated infective endocarditis].

Infective endocarditis is a disease with various presentations and conditions, so that the medical team faces many dilemmas, mainly on indications and timing for surgical intervention. The results of surgery depend upon many factors: the general preoperative condition of the patient, antibiotic treatment, timing of surgery, perioperative management, surgical techniques, postoperative management and follow-up. Optimal diagnosis and management of patients with infective endocarditis requires clinical judgment based on extensive experience. In spite of the current best practices and guidelines for surgical interventions in infective endocarditis, we face patients that do not "fall directly" into the obvious guidelines. This editorial covers some of the topics that remain controversial: timing for surgical interventions, selection of prosthetic valve type, technical aspects regarding complex infective endocarditis, and ethical decisions.

Anti-Bacterial Agents↗
PubMed2005

[Mitral valve repair of valve insuffficiency with broad and complex lesions due to infective endocarditis; report of a case].

Surgical intervention is necessary for the treatment of infective endocarditis, although antibiotic therapy has been shown to be effective for treatment of this disorder. Mitral valve infective endocarditis frequently presents with broad and complex lesions, and thus a variety of valve repair is needed. A 40-year-old woman with mitral valve insufficiency due to infective endocarditis underwent mitral valve repair. During the operation, torn chordae, aneurysm with perforation of the anterior leaflet, and torn chordae of the posterior leaflet were found. The chordae of the anterior leaflet were reconstructed and the aneurysm was excised, and autopericardial patch repair was performed. Then, resection and suturing of the prolapsing lesion of posterior leaflet were performed. Mitral valve repair preserves the left ventricular apparatus and function. Therefore, mitral repair results in better prognosis than valve replacement. The repair of the mitral valve should be attempted for the treatment of valve insufficiency due to infective endocarditis.

Adult↗
PubMed2005

Nosocomial methicillin-resistant Staphylococcus aureus endocarditis with splenic abscess in a pregnant woman.

A 36-year-old, 7-week-gravida patient with catheter-related nosocomial infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA) is presented in this paper. The patient was admitted to our hospital because of carbon monoxide intoxication. After 14 days, MRSA catheter-related bacteremia developed. The central venous catheter was immediately removed, and teicoplanin therapy was started. Because of persistent fever, leukocytosis, and high C-reactive protein values, endocarditis was suspected. A transesophageal echocardiogram revealed 19-mm vegetation on her mitral valve, confirming the diagnosis of endocarditis. Gentamicin and rifampicin were added to the therapy regimen, and the dose of teicoplanin was increased to 12 mg/kg-day. After 8 days, a splenic abscess was detected by ultrasonography. Vegetation excision, mitral valve replacement by open-heart surgery and splenectomy were performed in the same operation. Antibiotherapy was continued for 6 weeks after surgery, and the patient's condition improved. The development of endocarditis could be prevented by proper clinical practices.

Abscess↗
PubMedDate not supplied

Prosthetic valve endocarditis.

Prosthetic valve infective endocarditis represents a defined pathological entity which follows an epidemiological and nosological pattern in accordance to an arbitrary classification. Chronologically it is divided into the entities of early and late prosthetic valve endocarditis, each with its own unique characteristics. The clinical features, complications and diagnosis do not vary much from native valve endocarditis. There are clear and precise indications to aid in the diagnosis and treatment of this entity which differ from native valve endocarditis.

Anti-Bacterial Agents↗
PubMed1992

[An increased incidence of bacterial endocarditis in chronic inflammatory bowel diseases].

Of 92 consecutive patients treated for proven native valve endocarditis three had ulcerative colitis and 2 Crohn's disease. All 5 patients developed severe complications; three had to undergo emergency valve replacement. With a prevalence of 64.1/10(5) cases of inflammatory bowel disease the calculated incidence (5/92) revealed a significant over-representation of inflammatory bowel disease among patients with proven endocarditis (p less than 5.08 x 10(-9)). Possible explanations may be the suppression of cellular immune defense by therapeutic interventions, high frequency of bacteremia caused by increased permeability of the damaged mucosa for bacteria and a higher incidence of diagnostic and therapeutic interventions in this patient population. Therefore, prophylaxis for bacterial endocarditis should be carefully considered before expected bacteremias in patients with highly active inflammatory bowel disease even in the absence of cardiac factors predisposing to bacterial endocarditis.

Adult↗
PubMed2006

Aspergillus flavus endocarditis--to prevaricate is to posture.

Fungal endocarditis represents both a diagnostic and therapeutic challenge to the treating team. The critical care physician will see a rising incidence as older and more immuno-compromised patients are being supported in their intensive care units. Aspergillus sp. endocarditis represents less than 25% of all cases of fungal endocarditis and is associated with a mortality of around 80%. Early diagnosis may assist with definitive management. We review a case of Aspergillus endocarditis, and review the literature as to optimal methods of detection, imaging modalities of choice, and management, both surgical and medical.

Aspergillosis↗
PubMed2006

[Infective endocarditis and outpatient practice].

The incidence of infectious endocarditis is fairly stable over the past decades. It is estimated at roughly 3-4 case per patient-year. However, as a consequence of medical progress, Staphylococcus aureus endocarditis has become more prevalent. This is particularly true for health-care associated endocarditis, especially in iv-drug abusers or hemodialysis patients. Mortality (15-20% of patients in the last series) remains high. About 50% of patients undergo surgical treatment, whereas outpatient therapy is more and more frequent for highly selected subgroups of patients without complications and infected with low-risk organims. The present paper reviews in detail the epidemiology of infective endocarditis and discuss in detail the different out-patients therapies.

Endocarditis↗
PubMed2006

[Results of observation of infective endocarditis patients during 1965-2005].

AIM: To clarify the trends in infective endocarditis by our experience for 40 years. MATERIAL AND METHODS: During the last 40 years (1965-2005) we observed 620 patients with infective endocarditis (IE). There were 615 patients with subacute IE (99.2%) and only 5 patients with acute IE (0.8%). There were 402 males (66.8%) and 218 females (35.2%). The age was 16-84 years (mean age 53 +/- 17). We studied the finding of hemoculture, echocardiography, immunological investigations, the levels of C-reactive protein. RESULTS: Streptococcal endocarditis runs a standard course, but more often we encountered staphylococcal, enterococcal endocarditis with a severe course. Predisposing cardiac disorders in 264 IE patients were rheumatic heart disease, congenital heart disease, mitral prolapse, involutive valve disease, hypertrophic cardiomyopathy, prosthetic valve. CONCLUSION: Conventional and unconventional IE cases, recurrent IE, current criteria of IE are described.

Adolescent↗
PubMedDate not supplied

Subacute bacterial endocarditis presenting as polymyalgia rheumatica or giant cell arteritis.

OBJECTIVE: To report on several patients with subacute bacterial endocarditis who were initially presumed, incorrectly, to have polymyalgia rheumatica or giant cell arteritis. METHODS: We report 3 cases of subacute streptococcal endocarditis mimicking giant cell arteritis in 2 cases and polymyalgia rheumatica in one. We reviewed the literature through Medline search of French and English-language articles published between 1966 and 2005 and found 5 similar cases. RESULTS: Shoulder and/or pelvic girdle pain was associated with neck or back pain in all patients. Scalp tenderness, bilateral jaw pain, amaurosis fugax were present in 2 patients. One patient had no fever. Two patients were treated with corticosteroids with initial good clinical response in one. Appropriate antibiotic therapy resulted in the rapid disappearance of rheumatic complaints in 2 patients and achieved a definitive cure of endocarditis in all cases. CONCLUSION: Rheumatologic symptoms may hinder the correct diagnosis of infective endocarditis in patients who present with a clinical picture suggesting polymyalgia rheumatica or giant cell arteritis. In such cases, blood cultures should be systematically drawn.

Adrenal Cortex Hormones↗
PubMed2006

Infective endocarditis in the era of intracardiac devices: an echocardiographic perspective.

Although the role of echocardiography is well established in the management of native valve and prosthetic valve endocarditis, the recent introduction of intracardiac devices, including pacemakers, implantable defibrillators, closure devices, and ventricular assist devices, has expanded its utility. Echocardiography permits the direct imaging of valvular vegetations, and it allows for the identification of structural complications of endocarditis. It is useful for characterizing the hemodynamic consequences of the infection. It can also provide prognostic information concerning risk of embolization and/or need for cardiac surgery. This article reviews the roles of transthoracic echocardiography and transesophageal echocardiography in the evaluation of patients with native valve endocarditis, prosthetic valve endocarditis, and infections involving a variety of nonvalvular cardiovascular devices.

Clinical Trials as Topic↗
PubMed2006

Native double-valve endocarditis by Mycobacterium fortuitum following percutaneous coronary intervention.

Infective endocarditis caused by atypical mycobacteria, especially Mycobacterium fortuitum, is rare. Most reported cases involve diseased valves or prosthetic heart valves. Only four cases of native valve endocarditis caused by this organism have been previously reported. Herein is reported a case of native valve endocarditis caused by M. fortuitum; the epidemiology and management of this rare cause of culture-negative endocarditis is discussed.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Fungal endocarditis after open-heart surgery. Report of 4 cases].

Four patients with fungal endocarditis after open-heart surgery were confirmed microbiologically. Two of them died, and the other 2 were treated with intravenous administration of miconazole. Clinical symptoms of the disease were similar to those of bacterial endocarditis, but headache and sweating were more predominant. This complication was likely to be found and treated with effective anti-fungi drugs. We suggest that reoperation is the only possible way to cure those with residual shunt or vegetation, and that prevention of postoperative fungal endocarditis is of great importance because of its refractoriness. Measures of preventing fungal endocarditis after open-heart surgery are discussed.

Adolescent↗
PubMed1991

[Left ventricular-right atrial shunt due to infective endocarditis--report of a case].

Acquired left ventricular-right atrial shunt is a very rare cardiac disease. Infective endocarditis, cardiac operative procedures, and thoracic trauma were reported as origins. We report a case of a patient with left ventricular-right atrial shunt due to infective endocarditis. A 53-year-old male who had aortic regurgitation due to infective endocarditis developed suddenly severe congestive heart failure. Two-dimensional and pulsed doppler echocardiography demonstrated left ventricular-right atrial shunt. Emergency operation was done. The fistula was found through the atrioventricular membranous septum. The position from the left view was just below the commissure between the right coronary cusp and non coronary cusp and the opening position from the right view was just above the septal leaflet of tricuspid valve. Aortic valve replacement and direct closure of fistula were done and patient's recovery was uneventful. Case reports of left ventricular-right atrial shunt due to infective endocarditis have been rarely seen, most of which were followed by poor prognosis. Surgical intervention in acute phase is recommended.

Endocarditis, Bacterial↗
PubMed1991

Prosthetic valve endocarditis due to Cardiobacterium hominis occurring after upper gastrointestinal endoscopy.

Bacterial endocarditis secondary to endoscopic procedures has been convincingly documented in only four cases. We describe a case of prosthetic valve endocarditis due to Cardiobacterium hominis that developed after upper gastrointestinal endoscopy. Because of this, we recommend subacute bacterial endocarditis prophylaxis in patients who have a prior history of endocarditis or valve replacement.

Aortic Valve↗
PubMed1990

Dental health, prophylactic antibiotic measures and infective endocarditis: an analysis of the knowledge of susceptible patients.

A questionnaire was administered to 338 cardiac patients susceptible to infective endocarditis seen at the outpatient clinic or a cardiac ward. The questionnaire consisted of a series of questions on the educational, social, familial and professional background, the medical and dental history and the knowledge of the patient on prophylaxis of infective endocarditis. Univariate analysis (chi-square test) and stepwise discriminant analysis were used to evaluate the factors responsible for the presence or absence of an acceptable degree of awareness of infective endocarditis. More than half of the patients had no knowledge on prophylactic measures. The time since the diagnosis of heart disease, an edentulous state, written instructions received in the past on prophylaxis, the location of the follow-up, the level of education and previous prosthetic valve surgery were factors retained by discriminant analysis. A discriminant score was calculated for each patient and permitted classification in subgroups with a high, intermediate and low probability of presence of knowledge. This was simplified by classifying patients according to the number of risk factors. An answer to one of the six variables, selected by discriminant analysis, unfavorable for the presence of knowledge, was considered as a risk factor. Risk factor analysis must be considered as an important tool in the education of patients on the risk and prophylaxis of infective endocarditis.

Adolescent↗
PubMed1990

[Quinolones in the treatment of bacterial endocarditis].

The authors submit available information on the restricted use of new antimicrobial chemotherapeutic agents--quinolones--in the treatment of bacterial endocarditis in experiments and under clinical conditions. Quinolones are not suitable for the treatment of endocarditis except when the aetiological agent is Ps. aeruginosa, enterobacteria and in some instances endocarditis caused by meticillin-resistant staphylococci. The mentioned aetiological agents, however, cause endocarditis only in cca 5-10%. The results of experimental investigations on animal models as well as case-histories from human medicine are promising in this respect.

4-Quinolones↗
PubMed1990

Infective endocarditis due to the CDC group M6 bacillus.

Although staphylococcal endocarditis has occasionally been associated with a TTP-like syndrome, a similar syndrome has not been reported with endocarditis due to aerobic gram-negative rods. We report a case of subacute bacterial endocarditis with a thrombocytopenic syndrome that at first resembled TTP which was due to an unusual gram-negative rod. This case emphasizes the need for repeated examination of the bacteremic patient to detect the changing murmurs of endocarditis.

Aged↗
PubMed1990

The evolving pattern of pediatric endocarditis from 1960 to 1985.

A diagnosis of endocarditis was made in 37 patients (three days to 21 years old) on the basis of the following: histology in 11; at least two positive blood cultures in patients with underlying cardiac disease in 22; less than two positive blood cultures, vegetations seen at echocardiography and a suggestive clinical syndrome in four. Twenty-six patients had primary endocarditis (17 with pre-existing cardiopathy, nine with normal hearts). The 11 others developed secondary endocarditis following heart surgery (early onset in six, late onset in five). The mean delay before diagnosis was prolonged 35.8 days. The clinical and laboratory findings included weakness in 36 patients, fever in 35, new or modified heart murmur in 14, positive blood cultures in 30, anemia in 12, high white blood cell count in 15, increased sedimentation rate in 14, and positive echocardiogram in 11. Etiologic agents isolated were: streptococci in 17, staphylococci in seven, miscellaneous germs in eight, and aspergillus in two. Mortality was greater in patients less than one year old, infected with aspergillus or without underlying heart disease. The present study suggests that childhood endocarditis remains uncommon but presents a poor prognosis with a mortality of 27% and a morbidity of 85.7%.

Adolescent↗