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  • Title: Clinical and echocardiographic correlations in right heart endocarditis.
    Author: Panidis IP, Kotler MN, Mintz GS, Ross J, Weber J.
    Journal: Int J Cardiol; 1984 Jul; 6(1):17-34. PubMed ID: 6746135.
    Abstract:
    UNLABELLED: The echocardiographic findings were correlated with the clinical findings and outcome in 23 patients with tricuspid valve or pulmonary valve endocarditis. There were 15 males and 8 females with a mean age of 33.1 +/- 8.4 years. Eighteen patients had tricuspid valve endocarditis, 1 patient had pulmonary valve endocarditis, 3 patients had concomitant mitral valve and tricuspid valve endocarditis, and 1 patient had tricuspid valve and pulmonary valve endocarditis. Twenty of the 23 (87%) patients had a history of intravenous drug abuse. The most common organisms were Staphylococcus aureus (10 of 23 patients or 43%), Streptococcus viridans (5 patients) and Pseudomonas aeruginosa (4 patients). Pulmonary manifestations with septic pulmonary emboli were present in 18/23 (80%) patients, and a regurgitant murmur in 16/23 (73%) patients. Vegetations on the tricuspid valve or pulmonary valve were detected in all patients who had 2D echo, but they were missed by M-mode echo in 2 patients. Nine of the 23 patients (40%) improved on medical therapy, 5 (21%) expired, and 7 (30%) required surgery (tricuspid valve or pulmonary valve replacement in 3, and tricuspid valve excision without replacement in 4). CONCLUSIONS: (1) 11 of 13 patients with persistent infection, multivalvular involvement, fungal or Pseudomonas infection and increasing size of vegetations by echo died or underwent surgery compared to only 1 of 8 patients without these features (P less than 0.01). (2) Staphylococcus aureus infection (10 patients) and flail tricuspid valve or pulmonary valve by echo (6 patients) were not predictive of outcome.
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