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PubMed2004

[Echocardiography--prognosis of the course of infectious endocarditis and long-term survival in this disease].

AIM: To determine prognostic opportunities of echocardiography (ECG) in infectious endocarditis (IE) basing on the assessment of microbial vegetations size and degree of valvular failure. MATERIAL AND METHODS: Of 114 patients with definite IE (72 male, 42 female), 90 ones had primary and 24 secondary endocarditis. The prospective study included all the survivors in the IE active stage--78 patients. RESULTS: Vegetations > 1 cm in size were detected in 50.8% patients, < 1 cm--in 49.2%. Hospital lethality in vegetations > 1 cm and < 1 cm was 25.8 and 16.1%, respectively. Thromboembolism rate was 81 and 64.2%, respectively. One-year survival was 78.7 and 71.4%, two-year survival 66.5 and 61.7%, three-year survival 66.5 and 49.4%, five-year survival--51.7 and 32.9% in vegetations < 1 cm and > 1 cm, respectively. Valvular regurgitation of the first degree was in 17.5%, of the second degree--in 41.9%, third-fourth degree--in 36.6% patients. Hospital lethality in mitral valve failure was 32.1%, in aortic and tricuspid failure--17.8 and 11.4%, respectively. CONCLUSION: EchoCG was most effective for predicting thromboembolism and cardiac failure. Valvular regurgitation of the third-fourth degree significantly correlates with severe cardiac failure. ECG is less informative for predicting hospital lethality.

Adolescent↗
PubMed1991

[Prognostic value of the indicators of central hemodynamics and the contractile capacity of the myocardium in surgical treatment of active forms of infectious endocarditis].

The article is based upon results of an analysis of surgical treatment of 57 patients with active infectious endocarditis. It was established that low parameters of central hemodynamics and contractile ability of the myocardium during the preoperative period determined by noninvasive methods are prognostically unfavorable due to high risk of the development of acute cardiac insufficiency after operation, especially in patients with destruction of the aorta valve.

Adolescent↗
PubMedDate not supplied

Microscopic polyangiitis following recurrent Staphylococcus aureus bacteremia and infectious endocarditis.

Secondary vasculitis resulting from unusual pathologic expressions of infections has been described and has important clinical significance. Infectious agents have also been implicated in the pathogenesis of different primary systemic necrotizing vasculitides. Infectious endocarditis is of particular importance in the differential diagnosis of a patient presenting with ANCA associated vasculitis. We report a well-documented case of a patient with recurrent Staphylococcus aureus bacteremia who developed bacterial endocarditis and also fulfilled the Chapel Hill Conference definitions for microscopic polyangiitis. To the best of our knowledge, it is the second case of bacterial endocarditis associated with both pANCA and anti-MPO specificity that fulfilled definitions for systemic necrotizing vasculitis. We emphasize the potential pathogenic role of infection as the trigger factor for the development of systemic vasculitis.

Aged↗
PubMed1989

[Preventive use of immunostimulants in patients with infectious endocarditis].

Leakadine++, levamisole++, proper-myl were used in the postoperative period in 36 patients operated upon for infectious endocarditis with regard for the character of the immunopathology found. The directed immunostimulation results in resolution of immunodeficiency and normalization of the immune status of the patients.

Adjuvants, Immunologic↗
PubMedDate not supplied

[Etiology of infectious endocarditis at the Instituto Nacional de Cardiologia Ignacio Chavez from 1976 to 1986].

We studied 85 cases of infectious endocarditis (IE) with an anatomical diagnosis (biopsy or necropsy). Most cases occur between the second and fourth decade of life; male/female ratio was 1/0.8; 45 had IE in a natural valve; 40 had prosthetic IE. Clinical diagnosis was established or at least suspected in 61 cases (72%); the most common misdiagnosis was acute rheumatic fever. Blood cultures were positive in 25 cases of natural valve IE (56%) and in 25 cases of prosthetic IE (63%). Half of those negative culture cases had a history of antimicrobial use before their arrival at the hospital. Those microorganisms which cause natural valve IE were: staphylococci (9), streptococci (8), Gram negatives (5), Candida sp (1), and two non-identified cases; 1 patient had a polymicrobial infection. Prosthetic IE was divided into early and late infections. The former was due to: staphylococci (4), streptococci (1), Candida sp (1); the latter: staphylococci (7), streptococci (4), Gram negatives (4), Candida sp, Mycobacterium fortuitum and Peptococcus (1 each), and in a single case Lactobacillus sp, presumably a contaminant.

Adolescent↗
PubMed1995

[Infectious endocarditis: the right time for surgery].

Valve repair is often required to maintain haemodynamic performance in patients with infectious endocarditis. Localizations on the aortic valve are frequent and lead to rapid, often severe, deterioration, especially when the valve ring and the septum are also infected. Conduction disorders and rupture of the abscess into the heart cavities are formal indications for surgery. Mitral regurgitation requires surgical repair less often and has a slower clinical course. The tricuspid valve generally tolerates infection well and surgery is only exceptionally indicated. An emergency situation due to heart failure occurring simultaneously with valve damage (ruptured mitral chordae) and moderate regurgitation, can most often be managed medically. Inversely, surgery is required when blood cultures are persistently positive and sepsis remains uncontrolled after 8 days of adapted antibiotics. Surgery is entertained when the risk of emboli is established echographically, although growth on valves is not in itself sufficient. Most operated cases also involve an initial embolic event. Conservative surgery (mitral or tricuspid plasty) should always be performed to avoid the long-term complications of prostheses: valve dysfunction (disinsertion or thrombosis), bacterial resistance, risk of embolism especially for mechanical valves, risk of brain haemorrhage related to anticoagulant therapy. When endocarditis develops on a prosthesis early after implantation reoperation is usually required, especially when certain organisms (yeasts, Staphylococcus aureus) are involved. Haemodynamic performance and bacterial resistance dominate the decision making processes which must be adapted to each individual case. Once the decision for surgery has been made, the operation should not be delayed in the hope a longer antibiotic course will be effective since prognosis worsens rapidly if the haemodynamic situation is allowed to deteriorate.

Decision Making↗
PubMed1998

[The surgical treatment of heart defects in active infectious endocarditis].

AIM: To elucidate significance of early diagnosis and results of surgical treatment of valvular defects in active infectious endocarditis (AIE). MATERIALS AND METHODS: Surgical outcomes were analyzed for 437 AIE patients with active AIE. The operation was made 10 months, on the average, after AIE onset. RESULTS: Total hospital lethality made up 11.2%. Total 5-year survival with account for hospital death was 77-80% in replacement of one valve and 61.6% in replacement of two valves (mitral and aortic). In natural course of the disease it was 16%. CONCLUSION: There was a direct relationship between hospital lethality and admission condition of the patients, advance of the inflammation. This urges early AIE detection and performance of operation before development of irreversible changes in the myocardium and other organs.

Endocarditis, Bacterial↗
PubMed1989

[A case report of aneurysm of the sinus of Valsalva due to infectious endocarditis with ASR].

A case (56 year-old, female) of the aneurysm of sinus of Valsalva due to infectious endocarditis with aortic stenosis and regurgitation was described. The patient was successfully operated upon by patch closure of the orifice of the aneurysm and aortic valve replacement with Medtronic Hall 23A. Post operative course was uneventful and discharged from the hospital at 37 post operative days in good condition.

Aortic Aneurysm↗
PubMed2001

[Bacterial cerebral aneurysms without infectious endocarditis: analysis of a case and review of the literature].

INTRODUCTION: Bacterial intracerebral aneurysms, which are a common complication of infectious endocarditis, are unusual without Osler's disease. EXEGESIS: From the case report of a man with a bilateral bacterial intracranial aneurysm without endocarditis resulting in an hypopituitarism, we undertook a literature review of bacterial intracerebral aneurysms without endocarditis. CONCLUSION: Although this review has found few cases, this kind of aneurysms seems to have different features from those secondary to infective endocarditis: younger age of incidence, majority of Staphylococcus aureus, clinical presentation as a thrombophlebitis of the cavernous sinus, location of aneurysm on bigger cerebral artery.

Adolescent↗
PubMed1993

[Infectious endocarditis in middle-aged and elderly patients].

The analysis is presented of clinical picture, running, therapy and prognosis of infectious endocarditis in 67 patients over 60. They appeared to develop progressive cardiac failure, frequent thromboembolism of the cerebral vessels. The disease is often associated with other age-related disorders, proved difficult for differential diagnosis. Elderly patients show resistance to antibacterial therapy more frequently and have worse prognosis for endocarditis outcome.

Aged↗
PubMed2004

[Engagement of the lungs in infectious endocarditis].

Clinical, biochemical, bacteriological, x-ray, electrocardiographic, ultrasonic and morphological examinations for pulmonary pathology were made in 230 patients with infectious endocarditis (IEC) treated in 1982-2001. Pulmonary involvement was found in 30% of the examinees. Pulmonary onset of IEC caused misdiagnosis in 11% cases. Its appearance can be recognized by fever (100% cases), chest pain (73%), cough (50%) and dyspnea (46%). Pulmonary affection and pulmonary onset of IEC were associated with disorders of the mitral (26 and 27%, respectively), aortic (17 and 8%, respectively), tricuspis (5 and 8%, respectively) valves or compound valvular heart disease (43 and 50%, respectively). Bacterial vegetations of the heart valves were detected in 60% patients with pulmonary lesions and 62% patients with pulmonary onset of IEC in transthoracic ultrasonography. Pulmonary lesions and pulmonary onset of IEC were caused primarily by staphylococci (73 and 67%, respectively).

Adult↗
PubMed1990

[Surgical treatment of aortic root aneurysm associating with infectious endocarditis].

From 1979 to 1989, aortic root aneurysms were encountered in 6 of the 30 patients who underwent surgical treatment for infectious endocarditis. Four patients underwent aortic valve replacement and direct or patch closure of the orifice of aortic root aneurysm. In additional 2 patients with infected aneurysm of right coronary sinus of Valsalva rupturing into the right ventricle, the aneurysm and infected tissue in the right ventricular outflow tract were completely resected and the defect of aortic sinus and VSD were closed with double Teflon fabric patches. All patients survived postoperatively, however, one patients died 1.5 months after the operation probably due to rupture of mycotic aneurysm of cerebral artery. Another late death seemed to be concerned with recurrent aortic root aneurysm, in which case direct closure of aneurysm had been performed. We believe that even if the aneurysm seems to be small, its orifice should be closed with the use of a fabric patch to prevent recurrent aneurysm formation.

Adult↗
PubMedDate not supplied

[Infectious endocarditis caused by Staphylococcus. Study at the Ignacio Chavez National Institute of Cardiology 1977-1987].

This is a descriptive survey of infectious endocarditis (EI) due to Staphylococci, collected at the Instituto Nacional de Cardiología "Ignacio Chávez", in a ten years period. All had anatomical and bacteriological diagnosis. There were 21 cases, this disease in not rare, and both coagulase-positive or negative Staphylococci were represented in similar proportion as etiologic agents. Coagulase positive organisms produce a clinical picture of septicemia and systemic boxicity, therefore early diagnosis and prompt therapy is forthcoming. Instead coagulase negative EI cause an insidious illness with late diagnosis, focal intramyocardial abscesses and low responsiveness to therapy explain the poor prognosis. It is impossible to differentiate with our present resources between Staphylococcal bacteremia and EI. We recommend, combined antimicrobial therapy and if necessary early surgical treatment.

Adolescent↗
PubMed2002

Subarachnoid haemorrhage associated with infectious endocarditis: case report and literature review.

Cases of subarachnoid haemorrhage (SAH) as a presenting feature or soon after initiation of antibiotics in infectious endocarditis (IE) have been reported. However, most had documented mycotic aneurysms as the source of haemorrhage. Reports of IE associated with SAH of unclear source are rare. A case of SAH associated with IE is reported. We also reviewed our data set on neurological complications of IE at Mayo Clinic Rochester from 1980 to 1996 for additional cases. In addition to the index case, we identified seven cases of SAH amongst 489 patients (1%) with IE for a total of eight cases. In six patients, initial cerebral angiography, magnetic resonance angiography or autopsy did not show aneurysm or other aetiology for the SAH. A mycotic aneurysm was noted in one case and the other patient had an unruptured mycotic aneurysm of the tip of basilar artery. SAH was located in the basal cistern in two patients, sylvian fissure in three, and hemispheric sulci in three. SAH is an uncommon complication of IE, and in the setting of IE a specific cause, such as mycotic aneurysm, may not be identified.

Adult↗
PubMed2006

[Infectious endocarditis associated with multiple mycotic aneurysms; report of a case].

A 68-year-old man was referred to our hospital with infectious endocarditis (IE) of the mitral valve complicated by mycotic aneurysms located in the right middle cerebral artery (MCA) and the superior mesenteric artery (SMA). After coil embolization of the SMA aneurysm during angiography, surgical treatment of the MCA aneurysm was carried out. Antibiotic therapy for Enterococcus faecalis was continued throughout this period. After his IE was controlled, mitral valve repair was performed. The old vegetation on the edge of the anterior leaflet was resected and the defect was covered by transferring the posterior leaflet using the flip-over technique. Since there is no agreement about the optimum treatment of IE associated with multiple mycotic aneurysms, it is important to carefully plan the management of individual cases.

Aged↗