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At least 1,675 records · Page 93Linked to original sources
PubMed1987

Sinus of Valsalva aneurysm complicating bacterial endocarditis in an infant: diagnosis with two-dimensional and Doppler echocardiography.

Sinus of Valsalva aneurysm is a rare complication of bacterial endocarditis in infancy and childhood. This report describes an infant with congenital aortic stenosis who developed bacterial endocarditis after abdominal surgery and placement of indwelling central venous catheters for long-term parenteral nutrition. Bacterial endocarditis in this infant was complicated by the development of an aneurysm of the left sinus of Valsalva. Surgical intervention was necessary because of gradual expansion of the aneurysm with compression of the adjacent right pulmonary artery and descending aorta. Two-dimensional and Doppler echocardiography proved useful for the initial diagnosis and serial follow-up of this unusual disorder and for its successful surgical management.

Aortic Aneurysm↗
PubMed2002

Special issues in the management of infective endocarditis caused by gram-positive cocci.

Gram-positive cocci, mainly streptococci and staphylococci, continue to cause the majority of cases of infective endocarditis. Among the streptococci causing IE, the long-standing predominance of oral or viridans-group streptococci has progressively faded, while the number of cases caused by "enteric streptococci" (Streptococcus bovis and enterococci) has increased. While most oral streptococci and S. bovis strains remain fully sensitive to penicillin, nutritionally variant streptococci--now renamed Abiotrophia--and enterococci can exhibit resistance to penicillin and/or glycopeptides that makes endocarditis more difficult to treat. Among the staphylococci causing endocarditis, the increasing proportion of coagulase-negative and methicillin-resistant strains observed in recent years has changed the approach to choice of antibiotic therapy. The purpose of this paper is to focus on some new aspects of the management of antibiotic therapy of IE due to streptococci and staphylococci, including recent developments such as once-daily aminoglycoside administration in IE, outpatient antibiotic therapy, and the evaluation of new antibiotics.

Acetamides↗
PubMed1998

Outpatient intravenous antibiotic therapy for endocarditis.

The clinical spectrum of endocarditis continues to evolve, as does its diagnosis and management. Outpatient parenteral antimicrobial therapy has been demonstrated to be safe and effective for medically stable patients with viridans streptococcal endocarditis. Other carefully selected and monitored patients with infective endocarditis may also be considered for completion of therapy outside the hospital setting.

Anti-Bacterial Agents↗
PubMed1996

Acute infective endocarditis. Diagnostic and therapeutic approach.

Acute bacterial endocarditis (ABE) is clinically distinct from subacute bacterial endocarditis in terms of pathologic virulence, acuteness and severity of illness, complications, and prognosis. The term infectious endocarditis may be useful as a general term but conveys no meaningful clinical information. ABE presents as an acute, fulminant intracardiac infection with fevers (temperature > 102 degrees F) that are caused by highly virulent known pathogens. Septic embolic phenomena, valve dysfunction, and congestive heart failure are characteristic. Parenteral and oral antibiotic treatment regimens are discussed.

Acute Disease↗
PubMed2003

Transesophageal echocardiographic identification of an aortic root to right atrial fistula in a patient with acute streptococcal aortic valve bacterial endocarditis.

We describe the case of a patient with acute aortic valve endocarditis complicated by aortic insufficiency, perivalvular abscess, and aortic root to right atrial fistula caused by Streptococcus pneumoniae bacterial infective endocarditis. Although typically of low sensitivity for the diagnosis of myocardial abscess and similar complications of infective endocarditis, transthoracic echocardiogram successfully identified this relatively uncommon complication that was later confirmed by transesophageal echocardiography and at time of operation.

Aortic Diseases↗
PubMedDate not supplied

Right aortic sinus of Valsalva-to-right ventricle fistula complicating bacterial endocarditis of membranous ventricular septal defect: evaluation by two-dimensional, color flow, and Doppler echocardiography.

Rupture of the aortic sinus of Valsalva into the right ventricle is a rare complication of bacterial endocarditis. The majority of previous cases have been reported in patients with aortic valve endocarditis. This report describes this complication in association with infective endocarditis of a congenital membranous ventricular septal defect. Color flow imaging showed a mosaic-colored continuous flow signal from the right aortic sinus to the right ventricle. Continuous wave Doppler interrogation showed high-velocity systolic and diastolic flow signals due to continuous left-to-right shunt from the aorta to the right ventricle. The left-to-right shunt through a restrictive membranous ventricle septal defect was visualized as a mosaic-colored high-velocity systolic flow signal. These echocardiographic-Doppler findings permitted surgical correction of these defects without cardiac catheterization.

Adult↗
PubMedDate not supplied

Use of transesophageal echocardiography for improving detection of valvular vegetations in subacute bacterial endocarditis.

Subacute bacterial endocarditis is associated with significant morbidity and mortality. Valvular destruction, congestive heart failure, embolic phenomena, failure of medical therapy, and death are all more common in patients with echocardiographically discernible valvular lesions. Transthoracic echocardiography is often unsatisfactory for evaluation of vegetations in patients with chest wall deformities, lung disease, obesity, or prosthetic valves. The transesophageal approach affords uniformly high-quality images with excellent structural resolution. We present a case of suspected subacute bacterial endocarditis in a patient with equivocal diagnoses of vegetations on three separate transthoracic echocardiograms in whom transesophageal evaluation revealed obvious large vegetations that involved the aortic and mitral valves. Subsequent autopsy confirmed this diagnosis. The case illustrates the utility of a new imaging method for the detection of valvular vegetations. In view of the prognostic implications of detected vegetations, transesophageal echocardiography probably should be performed on all patients with suspected subacute bacterial endocarditis and equivocal results by transthoracic study.

Aged↗
PubMed1997

Gonococcal endocarditis: assessment by transesophageal echocardiography.

Gonococcal endocarditis is a rare but aggressive infection that has an alarming rate of perivalvular abscess and mortality. We present a case of gonococcal endocarditis with intracardiac abscess and fistula diagnosed by transesophageal echocardiography. Given the often acute nature of gonococcal endocarditis and its propensity toward abscess formation, transesophageal echocardiography should be considered early in the course of this infection.

Abscess↗
PubMed1999

Multivalvular surgery for infective endocarditis.

The short and the long-term results of our experience with 25 consecutive patients who underwent multivalvular surgery for infective endocarditis are analysed. Preoperatively, 20/25 (80%) patients were in New York Heart Association (NYHA) stage III or IV, and 2/25 (8%) patients were in cardiogenic shock. All the diseased valves were replaced with mechanical bileaflet prosthesis except seven mitral valves and one tricuspid valve, which could be repaired. Major postoperative complications occurred in 3/25 (12%) patients: a fatal cerebral haemorrhage, a reversible cerebellar syndrome and an intractable heart failure, which required transplantation. During a mean follow-up of 4.7 years (range 6 months to 16.8 years), 7/25 (28%) patients suffered from valve-related complications: five bleedings (one died), one embolic event and one prosthetic valve thrombosis. The actuarial freedom of valve-related event at 10 years was 61.8 +/- 12.4%. There was no prosthetic endocarditis. At follow-up, 20/21 (95%) survivors were in NYHA stage I or II. Long-term outcome in our patient population operated on for multivalvular endocarditis, is satisfactory with no recurrent infection and excellent functional results.

Adolescent↗
PubMed2003

Transoesophageal echocardiographic diagnosis of aortico-left atrial fistula in aortic valve endocarditis.

Intra-cardiac fistulas are rarely seen and they are estimated to account for <1% of all cases of infective endocarditis. Fistulization of paravalvular abscesses has been found in 6% to 9% of cases. This is a report of an unusual communication between the abscess region in the aortic root and the left atrium. A 44-year-old patient diagnosed with infective endocarditis had continuous fevers despite antibiotic therapy. Transoesophageal echocardiography revealed multiple vegetations on aortic valve, fistulization of an aortic root abscess to the left atrium and mitral regurgitation and moderate aortic regurgitation. At surgery, multiple vegetations on the aortic valve and a large abscess cavity establishing direct communication between aortic root and the left atrial cavity through a fistulous tract were discovered. This experience demonstrates the improved sensitivity and specificity of transoesophageal echocardiography in defining periannular extension of infective endocarditis.

Adult↗
PubMed2006

Ruptured sinus of valsalva and complete atrioventricular block complicating fulminant course of infective endocarditis: a case report and literature review.

Patients with infective endocarditis usually developed persistent fever and heart failure, especially when the valve structures are invaded and destroyed. Persistent bacteremia often leads to severe sepsis or overwhelming septic shock. Septic emboli from the vegetation will possibly result in systemic thromboembolism with multiple organ infarction. Patients with infective endocarditis have been reported to present with either ruptured sinus of Valsalva or complete atrioventricular block. However, both of these serious complications occurring in a single patient is rare. In this case report, we present a 54-year-old man with a previous history of alcoholic cirrhosis and chronic renal failure who suffered from a fulminant course of infective endocarditis. Simultaneously, ruptured sinus of Valsalva and complete atrioventricular block further complicated the preexisting septic shock and multiple organ failure.

Aortic Rupture↗
PubMed2001

Encephalopathy with staphylococcal endocarditis: multiple neuropathological findings.

BACKGROUND: Infective endocarditis is associated with serious neurological sequelae. OBJECTIVE: Here, we report a patient with Staphylococcus aureus endocarditis, secondary to congenital heart disease, with subacute onset of multiple neurological complications. RESULTS: Despite prompt antibiotic treatment with rapid sterilization of blood cultures, the patient died with brain herniation within 96 hours of admission. Neuropathological examination showed intraparenchymal hemorrhages, mycotic aneurysms, micro-abscesses and septic arteritis with accompanying infarction. Immunocytochemical studies revealed enhanced CD45 and GFAP immunoreactivity, together with adenosine A1 receptor detection on macrophages and microglia. CONCLUSIONS: Infective endocarditis is associated with multiple neuropathological lesions, which may contribute to its poor clinical outcome and activation of cells of monocyte-microglial lineage throughout the brain.

Adult↗
PubMed2001

Replacement of the mitral valve in an infant with group B streptococcal endocarditis.

Endocarditis due to group B streptococcus is very rare in infants, and may be associated with significant morbidity and mortality. Review of the literature reveals only a single reported case of an infant with this type of streptococcal endocarditis involving the mitral valve. This infant had underlying congenital heart disease, and died shortly after catheterization. We now report group B streptococcal endocarditis occurring in an infant with a structurally normal heart who was treated successfully by replacement of the mitral valve.

Endocarditis, Bacterial↗
PubMed2005

Subtle infective endocarditis and congenital cardiac disease.

Congenital cardiac disease is recognized as a major predisposing substrate for infective endocarditis. We present three cases of unanticipated intraoperative discovery of vegetations in patients with congenital cardiac malformations without preoperative clinical, laboratory or echocardiographic evidence of infective endocarditis, and their successful treatment. The relevant literature is reviewed, with emphasis of the need to maintain a high index of suspicion for the presence of endocarditis during repair of congenital cardiac lesions.

Adult↗
PubMed2006

Absent pericardium: at risk for endocarditis?

A 16-year-old girl with no previous cardiac problems presented to the casualty with septic shock. Investigations revealed endocarditis involving the mitral valve. At the time of surgery, she was noted to have a large left atrial appendage herniating into the left pleural cavity due to partial absence of the pericardium. Complete or partial absence of the pericardium is an uncommon congenital anomaly. Though various complications and presentations are reported, it has not been identified as a risk factor for endocarditis. We discuss the possible mechanism, and need for prophylaxis against endocarditis, in patients with absence of the pericardium.

Adolescent↗
PubMed1999

Listeria monocytogenes tricuspid valve endocarditis with septic pulmonary emboli in a liver transplant recipient.

Listeria monocytogenes has long been known as a pathogen of immunocompromised hosts, including solid organ and bone marrow transplant recipients. Its principal manifestations include bacteremia and meningitis. Endocarditis due to Listeria is far less common and in general affects the left side of the heart. We here report an unusual case of Listeria tricuspid valve endocarditis and septic pulmonary emboli in a sulfa-intolerant liver transplant recipient with a history of relapsing cytomegalovirus (CMV) hepatitis and an indwelling Hickman catheter. The literature on Listeria endocarditis and infections in transplant recipients is reviewed. The possible relationship between susceptibility to Listeria infection and the discontinuation of trimethoprim-sulfamethoxazole prophylaxis is of interest.

Adult↗
PubMed1992

The aetiology, epidemiology, pathogenesis and changing pattern of infective endocarditis, with a note on prophylaxis.

Infective endocarditis remains a life-threatening condition, although the number of deaths due to this disease has fallen by 80% over the past 50 years. Dental undergraduate and postgraduate teaching rightly emphasises the use of prophylactic antibiotics for those patients most at risk of developing the condition. However, the types of patients at risk have also changed with the increased use of antibiotics and availability of heart surgery. While oral microorganisms may be incriminated in infective endocarditis, causal organisms arise from a number of other sites and in many cases the portal of entry is unknown. It is now thought that the proportion of cases that are apparently dentally related is probably smaller than previously believed. This article concentrates on the mechanisms by which this disease occurs, an area which is often poorly understood by undergraduates and postgraduates alike. An extract is included from the Lancet, which provides the most recent recommendations for endocarditis prophylaxis.

Adolescent↗
PubMed1995

Management of the orthodontic patient 'at risk' from infective endocarditis.

There are no clear guidelines for the application of current antibiotic prophylactic regimes to orthodontic patients at risk from infective endocarditis. In order to ascertain current practice, a survey on various aspects of the management of orthodontic patients at risk from infective endocarditis was undertaken. Questionnaires were sent to all 1038 members of the British Society for the Study of Orthodontics and the British Association of Orthodontists. A total of 518 replies were received, 480 (46%) of which were completed in full and analysed. Eight cases of infective endocarditis associated with orthodontic treatment over a 44-year period were reported. The majority of respondents underestimated the number of at risk patients likely to be encountered over a 5-year period. Most orthodontists routinely contact the medical practitioner (62%) or hospital consultant (65%) for advice on the prescription of prophylactic antibiotics. Only 58 (12%) claimed to have refused orthodontic treatment for at risk patients. The majority of respondents advise the use of antibiotic prophylaxis for band placement and removal and manipulation of an unerupted tooth. A high standard of oral hygiene must be established prior to orthodontic treatment for at risk patients. Antibiotic prophylaxis in orthodontics should be used for procedures which cause gingival trauma eg band placement and removal. The daily use of a chlorhexidine mouthwash during treatment and prior to appliance adjustment is recommended.

Adolescent↗