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PubMed1980

[Non-bacterial thrombotic endocarditis. Autopsy study, clinico-pathological correlations (author's transl)].

During the course of 6 000 autopsies, the number of cases of non-bacterial thrombotic endocarditis discovered was 130 (absolute frequency of 2.1 p. cent). Frequency was highest among patients with cancer, of which there were many in this series (4 p. cent of 2 287 autopsies). In 83 p. cent of cases, therefore, the endocarditis was of paraneoplasic origin, usually associated with adenocarcinomas, especially those of bronchopulmonary, pancreatic or gastric origin. Less frequently, they developed during the course of shock or debilitating affections. The endocarditis lesion consists of a coagulated fibrin and platelet mass without microbial germs, located electively on the mitral and aortal valves. Emboli are a frequent consequence (47 p. cent of cases) affecting primarily the central nervous system, the kidneys, spleen, and hart. Ischemic effects of these latter, observed in 75 p. cent of cases, are generally latent. In some cases they produce clinical manifestations, and they may be the cause of death from a cerebral or myocardial infarct. Pathological examination demonstrates the frequent association of these endocarditis lesions with often multiple vascular thromboses, and disseminated intravascular coagulation affecting the same regions as the emboli. This emphasizes the major role of coagulation disorders in their genesis.

Disseminated Intravascular Coagulation↗
PubMed1981

[Tricuspid endocarditis in heroin addicts (author's transl)].

Two cases of tricuspid endocarditis due to Staphylococcus aureus in two young heroin addicts are reported. In one of them there was concomitant aortic valve involvement. The clinical picture was typical. Tricuspid and aortic valve vegetations were demonstrated by cardiac ultrasonography. The relatively good prognosis of tricuspid endocarditis due to Staphylococcus aureus was confirmed in one of the cases in whom an excellent response to therapy with cephalothin and gentamicin was obtained. Simultaneous aortic involvement worsens the prognosis considerably. The clinical features characteristic of endocarditis in heroin addicts are reviewed, with emphasis in those that permit to distinguish them from endocarditis in the general population. Although only indirect data are available the disease will probably be seen with increasing frequency in Spain.

Adolescent↗
PubMedDate not supplied

Evaluation of antimicrobial agents in the rabbit model of endocarditis.

The placement of a sterile polyethylene catheter in the heart of a rabbit results in nonbacterial thrombotic endocarditis characterized by an accumulation of fibrin strands, erythrocytes, and platelets that adhere to the endothelial surface. These elements form a nidus where a pathogen, when introduced by injection, lodges, multiples, and develops vegetations typical of infective endocarditis. In the rabbit model, endocarditis induced by Staphylococcus aureus or viridans group Streptococcus resembles the human disease in clinical and bacteriologic features and in response to antimicrobial therapy. The rabbit model thus affords a means of evaluating the therapy of endocarditis. The end points of therapeutic response are culture-negative vegetations and failure to relapse. On the basis of these criteria vancomycin was found to be more rapidly effective in curing an infection caused by a single strain of S. aureus than penicillin or cefazolin and as effective as a combination of penicillin and gentamicin.

Aminoglycosides↗
PubMed1980

Aspergillus terreus infective endocarditis on a porcine heterograft valve.

We present the first reported case of Aspergillus endocarditis occurring on a porcine heterograft prosthesis and discuss the literature regarding both Aspergillus endocarditis and endocarditis on a porcine valve. A 65-year-old man underwent aortic valve replacement with a porcine heterograft. Several weeks later he exhibited signs of infection and then of valve failure. Upon removal, the porcine valve substance was found to be grossly infiltrated and destroyed by the Aspergillus organism. The porcine valve has an excellent reputation of being resistant to infection and relatively easy to sterilize by medical management alone. Several surveys attest to the low incidence of endocarditis. Because of our experience with the destruction caused by Aspergillus, however, and because antimicrobials generally fail to eradicate this organism, we urge prompt operation to remove the heterograft valve involved with infection by this organism. The valve diseased with Aspergillus should be replaced with a mechanical prosthesis. In the aortic position, extra-anatomic replacement should be considered to facilitate eradication of periannular infection postoperatively.

Aged↗
PubMed1995

[Septicemia and endocarditis related to transvenous pacing leads of pacemakers: surgical indications and results].

Endocarditis of transvenous pacing leads is a rare condition. The authors review a series of 15 patients who developed bacteriologically proven septicaemia and/or endocarditis related to transvenous pacing leads, operated between 1988 and 1993. The interval between the last manipulation of the pacemaker and the onset of endocarditis was about 6 months. Six patients had had haematoma and/or infection of the pacemaker site. Endocarditis presented with chronic pyrexia (14 cases) associated with septicaemia (6 cases) and chronic local suppuration (1 case). The interval between the beginning of the pyrexia and the diagnosis was 3.4 months. Echocardiography showed a mass attached to the pacing lead in 8 cases and tricuspid valve vegetations in 4 cases. Blood cultures were positive in 13 patients and local wound swabs identified the organism in 1 patient. The commonest causal agent was the staphylococcus (epidermis in 7 cases, aureus in 4 cases). Appropriate antibiotic therapy was only effective in 1 case. The surgical indication in 13 cases was persistence of infection associated with pulmonary embolism (3) or tricuspid regurgitation (2). Complete ablation of the prosthetic material was performed by a peripheral vascular approach (2 cases), by a right atrial approach (1 case) and under cardiopulmonary bypass in 12 cases. The peroperative findings were of tricuspid valve vegetations (4 cases), thrombi on the pacing lead (7 cases) or in the right heart chambers (2 cases) or pulmonary artery (2 cases). The associated procedures performed under cardiopulmonary bypass were tricuspid valve repair (2 cases) and pulmonary thrombectomy (2 cases). Temporary and permanent epicardial leads were implanted in 10 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

[Valve repair or valvulectomy without replacement for infective endocarditis: a report of 11 cases].

Recently advances in early diagnosis of infective endocarditis (IE) by echocardiography provide for IE as a target disorder for valve repair. Valvulectomy without replacement might be still better operation of choice for some cases of intractable right-sided endocarditis. For our experience in 11 cases of valve repair or valvulectomy without replacement for IE, actuarial survival and reoperation-free rate at 6.8 years of mean follow-up after surgery was 81.8% and 90.9%. Persistent infection and intraoperative evaluation of the residual regurgitation was the point for postoperative management after these procedures. Although an elaborative valve repair should be applied for right-sided endocarditis, total pulmonary valvulectomy or regional tricuspid valvulectomy without prosthesis was available for destructive endocarditis.

Adolescent↗
PubMed1995

[A case of infective endocarditis with subtotal rupture of the posterior papillary muscle].

We recently experienced a case of infective endocarditis with multiple embolic complications. The patient was a 21-year-old male who was admitted to our hospital with high fever and dyspnea. Echocardiography showed vegetation on the aortic valve, severe aortic regurgitation and mild mitral regurgitation. Abdominal echography revealed large splenic infarction. First we performed aortic valve replacement and splenectomy. But infective endocarditis developed after surgery, and echocardiography revealed severe mitral regurgitation, which has been a change for the worse. After treatment with antibiotics, mitral valve replacement (the second surgery) was performed. Intraoperative findings were confirmative of subtotal rupture of the posterior papillary muscle. Histological examination of the subtotal ruptured muscle revealed presence of coagulation necrosis. The patient is healthy without recurrence of infective endocarditis after the second surgery. It is exceedingly rare to experience a case of surgically treated subtotal papillary muscle rupture due to infective endocarditis.

Adult↗
PubMed1995

[A case report of infective endocarditis complicated with Klippel-Trenaunay-Weber syndrome].

We reported an experience of successful aortic valve replacement due to active infective endocarditis complicated with Klippel-Trenaunay-Weber (KTW) syndrome which was characterized by limb hypertrophy, hemangioma, arteriovenous fistula and varicose veins. A 27-year-old man was admitted to our hospital because of severe dyspnea and high grade fever. Echocardiogram revealed severe aortic regurgitation and destruction of aortic valve due to active infective endocarditis. We performed aortic valve replacement and patch closure of annular abscess. As to vascular malformation of lower limb including arteriovenous fistula and varicose veins, surgical treatment was not undergone to avoid postoperative limb dysfunction. Although the origin of infective endocarditis was uncertain, the patient had peripheral vascular malformations. It was postulated that valvular endocardial injury might be occurred by cardiac volume overload due to arteriovenous fistula. The patients with KTW syndrome should be followed under careful observation since infective endocarditis may be one of the complications of the syndrome.

Adult↗
PubMed1994

[Infectious endocarditis in dentistry practice: recent controversies and modes of the use of antibiotic prophylaxis].

A survey by questionnaire to assess the daily practice of the antibiotic prophylaxis of infective endocarditis by physicians attending post-graduate schools of the Institutes of Oral Surgery and Stomatology (Group A n = 83) and Cardiology (Group B n = 46) of the Second University of Naples has been conducted. They were asked about dental procedure and cardiopathies that require prophylaxis for infective endocarditis, the relationship between infective endocarditis and rheumatic disease and the provision of antibiotic. Extraction of tooth and dental and oral surgery have been reported as the most risky procedures. Moreover provision of antibiotic prophylaxis was suggested to patients not at risk (pacemaker or coronary artery bypass), and was not suggested in high risk conditions (mitral valve prolapse with regurgitation and hypertrophic cardiomyopathy). Most of the 50-60% practitioners usually start the prophylaxis 24-48 hours before the procedure and prolong it for 48-72 hours. These results underline the need for improvement of the knowledge for the antibiotic prophylaxis of infective endocarditis.

Anti-Bacterial Agents↗
PubMed1994

[Non-bacterial thrombotic endocarditis complicating metastatic melanoma].

INTRODUCTION: Non-bacterial thrombotic endocarditis is defined by the presence of cardiac aseptic valvular vegetations made of fibrin and platelets. We report a case diagnosed ante mortem that occurred in a patient with metastatic melanoma. CASE REPORT: M. S., presented with a metastatic melanoma associated with an acute neurological deficit. Cerebral computerized tomographies and nuclear magnetic resonance showed occipital ischaemic lesions in the territory of the posterior cerebral artery. Cardiac echography showed large vegetations of the mitral valve. Bacterial endocarditis was eliminated. The diagnosis of non-bacterial thrombotic endocarditis was made, confirmed by post mortem examination. DISCUSSION: Non-bacterial thrombotic endocarditis is the second cause of neurological manifestations in patients with cancer. The presentation of our case was unusual because of an audible heart murmur and vegetations visible on echography.

Adult↗
PubMed1994

[Infective endocarditis in children and adolescents].

PURPOSE: To assess infective endocarditis (IE) predisposing factors, etiologic agents and hospital course in infants and adolescents. METHODS: We Studied 222 patients admitted under compatible IE diagnosis, from 1985 to 1990. The population of this study is fifty patients (23%) under 16 years of age. RESULTS: Rheumatic valvular disease, as predisposing cardiopathy was proeminent within 9 to 16 years of age, markedly Statistical difference when compared to age range of 0 to 8 years (p < 0.05). Among congenital cardiopathies, the most frequent were: interventricular septal defect (26.0%) and tetralogy of Fallot (21.7%). Blood cultures, surgical material or emboli cultures were positive in 35 (70.0%) assessed patients. Streptococcus viridans (45.7%) and Staphylococcus aureus (42.8%) were the etiologic agents most often isolated. It was found that endocarditis by Staphylococcus aureus had mortality rate of 53.3% [(clinical (66.6%) and surgical (44.4%)], (p < 0.05) when compared to those by Streptococcus viridans; with total mortality of 6.2% (no clinical death and 16.6% in the surgical group). Total in-hospital mortality (clinical and surgical) was 26.0% (13 deaths). CONCLUSION: IE in infants and adolescents in this studied population presented Streptococcus viridans responsible for 46.7% of patients with endocarditis and the Staphylococcus aureus for 42.8% were the etiologic agents most often found. Total, clinical and surgical mortality was greater in patients with endocarditis by Staphylococcus aureus when compared with those by Streptococcus viridans. Among the congenital cardiopathies, whether operated on or not, ventricular septal defect and of Fallot's tetralogy were the most involved ones; rheumatic cardiopathy Still remains a significant predisposing factor to infective IE in our country.

Adolescent↗
PubMed1995

The impact of aortic valve homografts on the treatment of aortic prosthetic valve endocarditis.

Prosthetic valve endocarditis, which is an uncommon but potentially fatal complication of valve replacement, may result in annular abscess formation (mechanical valves) or primarily leaflet infection (xenografts and homografts). Insertion of a mechanical or xenograft valve in the setting of aortic root infection carries a risk of reinfection, which is highest in the first 4 months after valve replacement. In contrast, the homograft aortic valve does not have this early risk of prosthetic valve endocarditis, but instead a constant and low risk across time. Because of this apparent intrinsic resistance to infection, the aortic homograft valve is the replacement device of choice for prosthetic valve endocarditis. An additional advantage of the homograft aortic valve for prosthetic valve endocarditis is the fact that this device has the flexibility to enable its use even in extensive aortic root destruction, including left ventriculo-aortic discontinuity. The homograft valve can be inserted as a root replacement after excision of the infected aortic root, or as a subcoronary or cylindrical technique for less extensive infection.

Aortic Valve↗
PubMed1995

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

Prosthetic aortic valve endocarditis is associated with significant morbidity and mortality despite aggressive medical and surgical treatment. In most cases, surgery is the only curative treatment modality, and these operations can be extremely challenging due to often extensive perivalvular tissue destruction. The currently recommended treatment for these advanced infections is thorough debridement and aortic root replacement with a homograft, although it seems that equally good results can be achieved with composite valved conduits. Enthusiasm for the use of the pulmonary autograft as described by Ross for the treatment of noninfective aortic valve disease is increasing, but use of the pulmonary autograft in the treatment of aortic valve endocarditis is uncommon. We have used the Ross operation as total root replacement with success in 11 patients with native or prosthetic aortic valve endocarditis. This article describes the use of this treatment modality in five of these patients between 10 and 72 years of age with prosthetic aortic valve endocarditis. Follow-up extending to 22 months shows excellent results with no mortality and no reinfection. The pulmonary autograft seems to be technically and uniquely well suited for these cases, and it has growth potential, excellent hemodynamics, and a low risk of reinfection, thrombosis, and embolic complications, without anticoagulation.

Adolescent↗
PubMed1995

The surgical treatment of patients with prosthetic valve endocarditis.

Prosthetic valve endocarditis is associated with high mortality and morbidity. Although antibiotics alone may sterilize an infected prosthetic valve, adjunctive surgical therapy is often necessary. Depending on the virulence of the offending microorganism, the type of prosthetic valve and the site where it was implanted, the infection spreads into paravalvular structures, producing abscess. Systemic embolization of infected material may cause metastatic abscess. Thus, timing of surgery in these patients is crucial to optimize clinical results. An aggressive approach is justifiable in most patients with prosthetic valve endocarditis. It is believed that radical resection of all infected material and reconstruction of the heart and annuli with fresh autologous or glutaraldehyde-fixed bovine pericardium offer the best chance to eradicate the infection. Prolonged antibiotic therapy is also necessary in these patients. In the author's personal experience with 45 patients with prosthetic valve endocarditis, the infection was limited to the valve in 10 patients and had extended into the surrounding tissues in 35. The operative mortality rate was 13%. The actuarial survival at 5 years was 61% +/- 5%. These results support the premise that radical resection of all infected materials offers a good chance for curing prosthetic valve endocarditis.

Abscess↗
PubMed1993

[Prosthetic valve endocarditis: current problems].

Prosthetic valve endocarditis is a rare complication of valve replacement surgery but carries a grim prognosis. The physiopathology of this condition allows identification of two clinically distinct forms based on their bacteriological profiles and outcome: early endocarditis, diagnosed in the first year following valve replacement is observed in 0.7 to 3% of cases: staphylococci are the predominant organism as contamination usually occurs at operation. The prognosis is poor due to the high incidence of complications and the mortality rate is about 60 to 70%; late endocarditis: diagnosed after the second year, it is observed in 0.5 to 1% of cases per year. Contamination is due to bacteraemia and the commonest organisms are the streptococci. The mortality rate is over 20%. The diagnosis is particularly difficult in chronic forms and those with negative blood cultures. Cardiac imaging in prosthetic valve endocarditis is mainly dependent on Doppler echocardiography especially using the transoesophageal approach which allows evaluation of lesion such as abscesses, vegetations and perivalvular leaks, and enables planning of treatment. Management is medico-surgical. Apart from symptomatic treatment of complications, antibiotic therapy using synergistic drugs at bactericidal dosages intravenously is essential as soon as bacteriological specimens have been sent for culture. Surgery is essential in early forms but may be avoided in uncomplicated late forms. The timing of surgery (the objectives of which are to excise the infected material, to repair destructive lesions and to implant a new valve) is a decisive factor in reducing the morbidity and mortality of this condition. Prophylactic measures have a particularly important role to play: they are based on pre- per- and postoperative guide lines.

Echocardiography, Transesophageal↗
PubMed1993

[Bacterial endocarditis occurring on native valves: identification of risk patients].

Analysis of the large series of infective endocarditis reported in the medical literature allows identification of the principal poor prognostic factors. Of the clinical factors, the worst prognosis is observed in the most elderly patients, in those with persistence of the infections syndrome despite antibiotic therapy, those with cardiac failure or complications, principally arterial embolism (cerebral or peripheral). From the anatomical viewpoint, aortic valve endocarditis seems to carry a slightly worse prognosis than mitral valve endocarditis, but the extension of infection to the paravalvular region is the complication most likely to aggravate the condition. The infecting organism is also an important factor: non-streptococci, especially staphylococcal endocarditis, have a much worse prognosis. Finally, echocardiographic analysis of the vegetations allows identification of the cases with the highest risk of embolism: those with vegetations over 10 mm in size which appear very mobile. The appearance of signs of poor haemodynamic tolerance, the persistence of an infectious syndrome despite appropriate medical therapy and the detection of large, mobile vegetations by echocardiography should lead to early surgical referral: this attitude now provides good immediate and long-term results.

Age Factors↗
PubMedDate not supplied

[Ciprofloxacin in the treatment of staphylococcal endocarditis].

Ciprofloxacin was used in treatment of 5 patients with infectious endocarditis and bacterial vegetations on the values by the findings of the echocardiography. The hemocultures produced the growth of Staphylococcus epidermidis and S. aureus in 3 and 2 patients respectively. The degree of endocarditis was high in 3 patients and intermediate in 2 patients. The drug was administered intravenously in a dose of 200 mg 2 times a day for 4 weeks. The efficacy of the treatment was estimated by following-up the disease time course: the patients were examined prior to the treatment, every week during the treatment and after the treatment completion. The complex clinico-laboratory investigations showed that ciprofloxacin (Ciprinol, KRKA, Slavonia) is a highly efficient chemotherapeutic drug of the group of fluoroquinolones for the treatment of infectious (staphylococcal) endocarditis due to the sensitive microbes. The intravenous drug is useful in treatment of severe forms of infectious endocarditis. The drug is not toxic and well tolerated by the patients after its intravenous administration.

Adult↗
PubMed1993

Valve ring abscess associated with infective endocarditis: echocardiographic features and clinical observations.

The presence of a valve ring abscess in patients with infective endocarditis adds appreciably to the expected rates of morbidity and mortality. From January 1989 to October 1991, a total of 43 consecutive patients with infective endocarditis seen at National Taiwan University Hospital were enrolled in this study. There were 30 men and 13 women, ranging in age from 14 to 75 years (mean +/- SD 38.5 +/- 15.0 years). The presence of infective endocarditis was documented by surgery in 26 patients and was based on a clinical diagnosis in the remaining 17 patients. A valve ring abscess was detected in five patients, either by transthoracic or transesophageal echocardiography, and all were confirmed at surgery. Aortic valve endocarditis was more frequently found in patients with valve ring abscesses (100% vs 31.6%, p < 0.01), and the infecting organism was most often Staphylococcus aureus (60.0% vs 15.8%, p < 0.05). The proportion of urgent operations was also higher in the group with abscesses (80.0% vs 23.7%, p < 0.05). The hospital mortality was 40.0% in patients with abscesses and 5.3% in patients without abscesses, but the difference did not reach significance (p = 0.056). Transthoracic echocardiography identified valve ring abscesses in the first three patients, but transesophageal echocardiography was more useful in detecting abscesses located in the posterior aspect of the aortic root in the other two patients, in which the lesion was overlooked or only suspected by the transthoracic approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗