Vegetative Endocarditis Research Articles

Diseases of the Thorax

Diagnostic ultrasound is an important adjunct to existing methods in the diagnosis of thoracic disease in the horse. This article discusses scanning techniques, anatomy of the thoracic cavity, and how diagnosis of pleural effusion, pulmonary abscessation, pneumothorax, and vegetative endocarditis may be facilitated by ultrasound.

Uptake of hematoporphyrin derivative by valvular vegetations in experimental infective endocarditis.

Drugs that localize in valvular vegetations may be useful in the diagnosis and treatment of infective endocarditis. We therefore tested the hypothesis that parenterally injected hematoporphyrin derivative (HPD), which is concentrated in tumors and atherosclerotic plaques, localizes in the vegetations of experimental infective endocarditis. In 14 rabbits, various bacteria were given intra-arterially immediately after injury to the aortic valve. In 12 additional rabbits, sterile vegetations on the aortic valve were produced by the trauma caused by an indwelling catheter that had been in place over a long period. HPD, 2.5 mg/kg, was injected intravenously 1 to 2 days before the animals were killed in six rabbits with sterile vegetations and in seven rabbits with infected vegetations. In all rabbits, multiple vegetations on the aortic valve leaflets were identified. On exposure to ultraviolet light, strong porphyrin fluorescence of all vegetations, whether sterile or infected, was observed only in rabbits given HPD. In two rabbits given HPD 10 weeks after catheter implantation across the aortic valve, however, only mild fluorescence could be detected in healing endocardial vegetations. In frozen sections of HPD-laden lesions, a patchy distribution of fluorescence was observed that was similar to the pattern of HPD localization in atheromatous plaques. Since vegetations in experimental infective endocarditis selectively concentrate HPD, porphyrins could be useful in the diagnosis and treatment of infective endocarditis.

Vegetations in infective endocarditis. Clinical relevance and diagnosis by cross sectional echocardiography.

Cross sectional echocardiography identified vegetations in 45 of 62 (73%) patients who had clinical evidence of active infective endocarditis. The sensitivity of this technique in diagnosing vegetations in infective endocarditis was 93% and the specificity 89%. The predictive value of a positive test was 96% and that of a negative test 80%. Vegetations were detected with a similar frequency on the aortic and mitral valves. The incidence of valvar incompetence, congestive heart failure, and the need for surgical intervention was similar in the patients with and without vegetations. Embolism occurred in 47% of those patients with vegetations and in 12% of those without. The mortality rate was 27% in those with vegetations, and no patient without vegetations died. Thus cross sectional echocardiography is accurate in diagnosing vegetations in patients with infective endocarditis, and this finding identifies patients at high risk of embolic complications and death.

A Case Report of Ventricular Septal Defect with Bacterial Endocarditis and Pulmonic Valve Vegetation

Bacterial endocarditis has been well recognized as an important complication of congenital heart disease, such as ventricular septal defect, patent ductus arteriosus or pulmonary stenosis. The incidence of right sided bacterial endocarditis is lesser than left sided bacterial endocarditis. Also, pulmonic valve vegetation has been thought to be relatively uncommon. And pulmonary embolism is common in the patients with right sided bacterial endocarditis. So in a patient with fever and evidence of recurrent pulmonary infarction, changing heart murmurs and scattered pneumonic infiltrates, one should direct attention to the heart as a possible source of the infection. Echocardiography with M-mode, 2-D and Doppler mode represents the only noninvasive technic available for detecting vegetations in bacterial endocarditis. In fact, the technic is more sensitive in identifying these lesions than angiography. We experienced a case of ventricular septal defect with bacterial endocarditis, pulmonic valve vegetation and multiple pulmonary embolism diagnosed with Echocardiogram and lung scan, and confirmed by operation. Patch repair of ventricular septal defect, resection of pulmonic valve and vegetation and artificial valve formation with pericardium were done.

Two-dimensional echocardiographic diagnosis of intracardiac masses in infancy

Intracardiac masses in infancy are uncommon. Tumors, thrombi and vegetations of bacterial endocarditis are exceedingly rare in this age group. These masses are seldom diagnosed before the infant's death. In a review of two-dimensional echocardiograms performed from May 1979 to January 1981 on 741 infants less than 2 years of age, intracardiac masses were prospectively identified in 6 patients. All six patients presented with unexplained murmurs associated with either hemodynamic instability, arrhythmias or systemic emboli. One patient had a vegetation from bacterial endocarditis, one had an intracardiac thrombus associated with myocarditis, three had rhabdomyomas (two patients with tuberous sclerosis) and one had a fibro-fatty nodule attached to the eustachian valve. Two-dimensional echocardiography not only was important in the diagnosis, but also provided guidance in the medical and surgical treatment of these patients.

Mモードおよび断層心エコー法による牛の心疾患の診断

M-mode and two-dimensional echocardiography we useful for the diagnosis of bovine congenital and acquired heart diseases. Echocardiographic features were described in 7 bovine animals affected with dilated cardiomyopathy (two cases), traumatic pericarditis, bacterial pericarditis, vegetative bacterial endocarditis associated with ventricular septal defect, bicuspid aortic valve showing the prolapse of one valve leaflet, and suspected ventricular septal defect with the overriding aorta.

Clinical implications of large vegetations in infectious endocarditis

Clinical implications of large vegetations in infectious endocarditis

Clinical Implications of Large Vegetations in Infectious Endocarditis

Thirty-four patients with clinical infectious endocarditis were examined by M-mode and two-dimensional (2D) echocardiography. Vegetations were identified in 16 patients (47%) by M-mode and in 27 patients (87%) by 2D echocardiography. Vegetations identified by 2D echocardiography were categorized as small (less than 5 mm), medium (5 to 9 mm), or large (greater than or equal to 10 mm). Large vegetations were caused by a variety of organisms, had a higher incidence of surgery (44% v 0%), and had no increased incidence of stroke or death. The larger the vegetation, the more detectable it was by M-mode. Aortic valve vegetations were associated with a higher incidence of congestive heart failure (CHF) (67% v 14%) and stroke (44% v 9%). Four patients with large aortic valve vegetations had the highest complication rate; CHF developed in all four, two had valve replacement, one had a stroke, and two died.

Rifampin in experimental endocarditis due to Staphylococcus aureus in rabbits.

Rifampin possesses unique activity against Staphylococcus aureus. It is the most active antistaphylococcal antibiotic currently available and has been shown to be particularly effective in eradicating S. aureus from abscess cavities in experimental infections. However, resistance develops rapidly in vitro and in vivo when large numbers of organisms (10(6)-10(7)) are present, and use of combination therapy has been recommended. The use of combination therapy is complicated by the finding that in vitro the addition of rifampin may reduce (antagonize) the bactericidal effect of the beta-lactam antibiotics. This study examines the in vivo effect of treatment with a beta-lactam agent (cloxacillin), rifampin, or the combination on the eradication of S. aureus from cardiac vegetations in experimental endocarditis. Five different dosage combinations of the beta-lactam agent and rifampin were administered for a three-day period, and an attempt was made to correlate peak serum bactericidal titers with results of quantitative cultures of vegetations after therapy. In two of five regimens the combination of rifampin and cloxacillin produced enhanced efficacy in vivo (synergism); in two regimens the effect was no greater than the effect of either drug alone (indifference), and in one regimen the combination was less effective than either single-drug regimen alone (antagonism). Peak serum bactericidal titers often were predictive of the in vivo effect when high doses of cloxacillin were used but were not consistently predictive of in vivo results when rifampin was the agent responsible for the major therapeutic effect. Rifampin-resistant strains did not emerge in animals receiving combination therapy but were isolated from vegetations from several animals receiving rifampin alone.

Vegetative bacterial endocarditis in dogs; echocardiography diagnosis and clinical signs

ABSTRACTOver a two‐year period, three hundred and forty‐five consecutive canine patients of a Cardiology Specialty Clinic were screened for signs of bacterial endocarditis. Ten dogs were identified to have echocardio‐graphical signs suggestive of this disease. Their clinical and haematologic data are presented in tables, and the clinical diagnoses were confirmed by necropsies. The echocardiographic signs of bacterial endocarditis and the usefulness of this new technique are discussed.

Cefamandole-aminoglycoside therapy of experimental enterococcal endocarditis.

Cephalosporin-aminoglycoside therapy of human enterococcal endocarditis has been associated with a high incidence of clinical failure. The comparative efficacy of three cephalosporin antibiotics (cefamandole, cefazolin, and cephalothin), in combination with gentamicin, was studied in a rabbit model of enterococcal endocarditis. The cefamandole-gentamicin combination produced higher rates of cure, despite the administration of comparatively lower doses. Studies of antibiotic penetration into a fibrin thrombus indicated that cefamandole penetrated the thrombus readily. The greater efficacy of the cefamandole-gentamicin combination may be related to the superior penetration of cefamandole into the fibrin-rich vegetations of endocarditis.

Staphylococcus aureus bacteremia in diabetic patients: Endocarditis and mortality

The presentation and course of Staphylococcus aureus bacteremia in 27 diabetic patients (18 insulin-dependent) were compared with those in 34 nondiabetic patients. The groups were comparable in age, proportion with pre-existing cardiac valvular disease, community-acquired bacteremia, fever, and leukocytosis. Endocarditis (vegetation or new regurgitant murmur) was present in eight (30 percent) diabetics and four (12 percent) nondiabetics (p = 0.16). A primary focus of infection was present in 67 percent of diabetics and 65 percent of nondiabetics. Among those with a focus, six of 18 diabetics and none of 22 nondiabetics had endocarditis (p < 0.005). Fifteen of 54 (28 percent) patients who received appropriate antibiotic therapy died. After stratification for underlying illness, there was no mortality difference between those with and without endocarditis (three endocarditis deaths versus 1.78 expected), or between those with and without diabetes (four diabetic deaths versus 4.8 expected). Diabetics with staphylococcal bacteremia were more likely than nondiabetics to have endocarditis in the presence of a primary focus. They had no increase in mortality.

Echocardiographic Diagnosis of a Discrete Membranous Subaortic Stenosis with Aneurysm of the Membrane: A Hitherto Undescribed Entity

A case of echocardiographically-demonstrated congenital aneurysm of the subaortic membrane, confirmed at surgery, is presented. The echocardiographic pattern may create an impression of vegetations of bacterial endocarditis. We were not able to find a similar case in the literature.

Bacterial endocarditis and right atrial vegetation. Detection by two-dimensional echocardiography

Bacterial endocarditis and right atrial vegetation. Detection by two-dimensional echocardiography

Bacterial Endocarditis and Right Atrial Vegetation

PACEMAKER-induced endocarditis has traditionally been diagnosed by clinical suspicion and positive blood cultures. The present case shows that echocardiographic techniques can be used to record right-sided vegetation owing to endocarditis induced by an atrioventricular pacemaker. Report of a Case A 62-year-old man with an indwelling pacemaker was hospitalized for cyclic episodes of fever. Eight years previously he had suffered a myocardial infarction, and five years before this admission a permanent transvenous pacemaker electrode had been inserted into the right ventricle. His pacemaker generator was changed 18 months before admission, but had required no further attention. On admission the patient denied dyspnea or chest pain and gave no history of recent dental extractions, skin infections, or instrumentation. He had lost almost 16 kg in the year before admission. His blood pressure was 114/48 mm Hg, his pulse rate was 80 beats per minute, and his temperature was 37 °C. Conjunctivae and

Pathological study of infective endocarditis on Hancock porcine bioprostheses

A pathological study has been performed on 10 infected Hancock bioprostheses removed from nine patients who died of prosthetic endocarditis. The devices had been in place from 2 to 87 months (average 37.5), the interval between operation and onset of infection averaging 30 months. The offending organisms were Gram negative bacteria in three patients (Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens), Gram positive bacteria in two (Staphylococcus aureus and Streptococcus viridans), and fungi in four (Candida species in three and Aspergillus species in one). Gross examination of the explants revealed in most cases a vegetative endocarditis of one porcine valve leaflets. Septic embolization occurred in five cases owing to the high friability of the vegetations. Prosthetic valve incompetence was the commonest type to dysfunction observed because of tears, perforations, and even complete destruction of the cusps. Prosthetic valve stenosis following obstruction of the valve orifice by infected polypous masses was noted in two cases. Clumps of infective organisms were detected deep in the cusp tissue in most cases on histologic examination. Infection located on the paraprosthetic tissues, associated with ring abscess, valve detachment, and insufficiency, was observed only once. According to the results of investigation, endocarditis on porcine bioprostheses is associated with a better preserved native valvular ring as viewed at reoperation. Therefore surgical intervention appears appropriate in the presence of severe hemodynamic complications after adequate antibiotic treatment. However, infection of these particular prostheses still carries an extremely high mortality. In the present series, this poor outcome might be explained by the frequently associated septic and thromboembolic events.

Noninvasive methods for detection of valve vegetations in infective endocarditis

To determine the optimal noninvasive method for the demonstration of endocarditic vegetations, 35 consecutive episodes of clinically diagnosed endocarditis in 33 patients were studied with M mode and two dimensional echocardiography, and with gallium-67 citrate and technetium-99m stannous pyrophosphate cardiac scanning. Clinical criteria for the diagnosis of endocarditis were: temperature higher than 38 ° C; sustained bacteremia with at least three positive blood cultures; no extracardiac focus of bacteremia; and known underlying heart disease, a new or changing murmur or a history of intravenous drug abuse with radiologic evidence of septic pulmonary emboli. M mode echocardiography detected 18 vegetations in 17 of the 35 episodes of endocarditis studied (49 percent positive); two dimensional echocardiography detected 30 vegetations in 28 of the 35 episodes studied (80 percent positive). In contrast, no vegetations were detected with technetium-99m stannous pyrophosphate scanning, and only two gallium-67 citrate scans were positive. The advantage of the two dimensional echocardiographic technique over all others tested was particularly notable for the identification of aortic and tricuspid valve vegetations.

Two dimensional echocardiography in differentiating right atrial and tricuspid valve mass lesions

Atrial myxoma has been diagnosed on the basis of a characteristic M mode echocardiographic pattern of a mass of echoes appearing, with a lag phase, beneath the anterior leaflet of the mitral or tricuspid valve in diastole. However, this pattern is not specific for an atrial tumor. Two patients are described with tricuspid leaflet endocarditic vegetations whose M mode echocardiograms were strikingly similar to the M mode tracing from a patient with a large right atrial myxoma. In a fourth patient, artifact, resulting from the failure of lateral resolution of the atrial wall, was also capable of producing a mass of echoes appearing, with a lag phase, beneath the anterior tricuspid valve leaflet in diastole. In each patient, two dimensional echocardiography confirmed the presence or absence of a right-sided mass lesion and defined more precisely the location of the echocardiographic density relative to the right atrium and tricuspid valve. Because two dimensional echocardiography is capable of detecting anatomic relations in two distance dimensions and of visualizing movement of intracardiac structures relative to one another in real time, it can play an important role in the identification and differential diagnosis of intracardiac mass lesions.

Aspergillus Vegetative Endocarditis and Complete Heart Block in a Patient with Acute Leukemia

Aspergillus flavus vegetative endocarditis together with myocardial abscesses and pneumonitis developed in a patient with acute lymphocytic leukemia. The initial diagnosis was not suspected until 67gallium imaging revealed a radiographically undetectable thoracic abnormality. Despite apparently "early" diagnosis, antifungal therapy was inadequate to prevent disruption of the bundle of His, complete heart block and death.

Echocardiographic Features of Mitral Obstruction due to Bacterial Endocarditis

We describe a patient with mitral valvular obstruction due to vegetative endocarditis. The diagnosis was made before surgery by M-mode and two-dimensional echo-cardiograms, which revealed a mass of echoes obstructing the mitral orifice. This was confirmed subsequently at surgery. Both modes of echocardiography are of value in the noninvasive diagnosis of mitral valvular obstruction due to vegetative endocarditis, a condition which may be amenable to surgery for valvular replacement.