Bacterial endocarditis of the pulmonic valve. Association with atrial septal defect of the ostium secundum type.
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The visualization of vegetations by M-mode echocardiography in patients with infective endocarditis has been suggested to imply a poor prognosis regarding the development of major systemic emboli, congestive heart failure and the need for early surgical intervention. The question of using the finding of vegetations by echocardiography as an indication for surgery is controversial. To answer this question, 30 patients with the clinical diagnosis of endocarditis were studied by echocardiography. In 17 of the 30 (57 per cent) vegetations were present (aortic eight, mitral four, both mitral and aortic five), whereas in 13 (43 per cent) no vegetations were visualized. Infecting organisms were similar in each group; Streptococcus viridans being the most common. The patients with echocardiographically demonstrable vegetations had a higher incidence of congestive heart failure compared to the patients without (14 of 17 versus six of 13, p less than 0.05), major emboli (eight of 17 versus two of 13, p = NS) and need for valve surgery (17 of 17 versus two of 13, p less than 0.001). Mortality was not significantly different in the two groups (six of 17 versus three of 13, p = NS). Urgent or emergency surgery was required in 16 of 17 patients with vegetations. Thus, the demonstration of vegetations by echocardiography identified a subset of patients with more severe disease in whom early operative intervention was required.
Two cases of endocarditis secondary to permanent indwelling catheters are described. In both cases, the catheters were used for parenteral nutrition and became infected with Staphylococci. Secondary endocarditis developed on the tricuspid and aortic valves. Despite removal of the catheters and appropriate antibiotics, both patients died.
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A retrospective study was conducted at the University of Alabama in Birmingham Medical Center on patients diagnosed as having BE from the years 1969 to 1979, with emphasis on dental involvement. A major finding of this report revealed that 16 percent of the cases of BE had a history of recent dental care or pathology. Other results of this investigation included the following: (1) Streptococcus viridans was the predominant microorganism associated with BE; (2) the mortality rate relative to predisposing heart disease was highest for patients with prosthetic heart valves; (3) chronic valvular heart disease was the heart problem most susceptible to BE; (4) chronically abscessed teeth and periodontal disease may be initiating factors of BE.