• Journal of Chest Surgery
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• 제54권3호
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• pp.218-220
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• 2021

The simultaneous incidence of infective endocarditis and cervical spondylitis with an epidural abscess is rare, and quadriplegia as a complication after cardiac surgery is very rare. We recently observed quadriplegia after mitral valve replacement in an infective endocarditis patient with cervical spine spondylitis. With early symptom detection, immediate examination, and prompt surgical treatment, the patient successfully recovered without neurological symptoms.

• Journal of Chest Surgery
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• 제25권10호
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• pp.1055-1060
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• 1992

Clinical experience of 21 patients with infective endocarditis was reviewed. Endocarditis involved the left-sided valve in 16 cases, the right-sided valve in 2, and PDA in the remaining 3 patients. Valve abnormalities included leaflet perforation in 9 patients, chordal rupture in 2,; annular abscess in 6; and aorticoleft atnal perforation in 2. Sixteen patients underwent valve replacement[aortic valve replacement in 7 patients, mitral replacement in 4 and double valve replacement in 5], two had VSD closure with pulmonary valve excision, three had ductus arteriousus closure. The patients were classified into two groups. I ] Healed endocarditis group: including the patients who had completed a planned cou-rseof antibiotic therapy[N=10], II ] Active endocarditis group: patients in which operations were performed prior to completetion of antibiotic treatment course[N=11]. The indications for operation included congestive heart failure, embolism, and persistent sepsis. Organisms were predominantly streptococcus[N=5] and staphylococcus [N=4] followed by candida, moraxella, and E-coli. By NYHA functional classification, all patients were in Class III or IV preoperatively. There was only one operative mortality in patient from group II. All patients substantially, improved postoperatively with NYHA classification in class I or II. This study shows that early surgical intervention in patients with active endocarditis has desirable outcome.

• 대한소아치과학회지
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• 제27권2호
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• pp.208-215
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• 2000

선천성 심장질환 환자는 감염성 심내막염에 감수성을 가지고 있고, 치과치료후에 균혈증에 의해서 감염성 심내막염이 발생할 수 있다. 따라서 선천성 심장질환 환자에 있어서 감염성 심내막염을 유발할 수 있는 치과치료를 시행 시에는 예방적항생제의 투여가 추천된다. 1997년 미국 심장학회에서는 감염성 심내막염의 예방을 위한 개정된 지침을 발표하였다. 개정된 지침은 예방적 항생제 투여의 적응증, 항생제의 선택, 투여용량 등에 있어서 이전의 지침과 차이가 있다. 이전의 지침은 출혈을 유발할 수 있는 모든 치과시술에 대해서 예방적 항생제의 투여를 추천하고 있으나 개정된 지침은 술자의 판단에 따라 심한 출혈이 있는 경우에만 예방적 항생제를 투여할 것을 추천하고 있다. 또한 이전의 지침에선 술전과 술후 2회의 예방적 항생제 투여를 추천하였으나 개정된 지침에서는 술후 투여가 없어지고 술전 1회만 예방적 항생제를 투여 할 것을 추천하고 있다. 본 증례는 미국심장학회에서 최근에 발표한 선천성 심장질환 환자의 치과치료시의 예방적 항생제 투여 지침에 따라서 3명의 선천성 심장질환 환아를 대상으로 치과치료 후 그 예후를 관찰한 것이다.

• Journal of Chest Surgery
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• 제30권12호
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• pp.1175-1183
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• 1997

연구배경. 아동기의 전염성 심 내막염은 비록 드물게 발생하지만 심각한 임상경과를 밟을수 있는 질환이다. 수술적 요법을 포함하는 적절한 치료 방침 내지는 전략의 수립이 필수적이다. 방법. 1986년 9월부터 1996년 2월까지 총 19례의 전염성 심 내막염으로 수술 시행한 환자를 후향적으로 조사하였다. 남녀비는 8:11이고 평균연령은 70.6개월이었으며 주 중상은 발열,호흡 곤란이었다. 술전 시행한 심 에코상 14례에서 우종을 발견할 수 있었다. 선천성 기형이 15례, 후천성이 4례였고 원인균은 12례에서 동정되었으며 7례가 그람 양성 구균이었다. 적절한 술전 항균제 처치를 시행하였다. 결과. 전 례에서 심폐기 가동 하에 우종 제거를 포함한 수술적 치료를 시행하였다. 4례의 사망으로 21.1%의 사망률을 나타내었으며, 4례 모두가 선천성 복잡 심기형을 가진 환아였다. 누적생존율은 1년,5 년에 모두 79.0%였고, 재수술 없는 누적 생존율은 1년,5년에 모두 73.7%였다. 결론. 항생제의 획기적인 발전에도 불구하고 조기적 수술이 반드시 필요한 환아가 있으며 이 경우 동반된 심기형의 적절한 치료가 함께 요망된다.

• Journal of Chest Surgery
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• 제23권2호
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• pp.370-376
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• 1990

From April, 1981, through March, 1989, 30 patients had received valve replacements and 1 patient had received foreign body removal for infective endocarditis at Seoul National University Hospital. There were 22 male and 9 female patients, ranged in age from 22 to 59 [mean 34.9] years. Twenty-three had native valve endocarditis, 7 had prosthetic valve endocarditis and 1 had infected transvenous permanent pacemaker electrode in right heart. Twenty-four required operation during active phase of disease and 7 during inactive phase. The infecting organism was Streptococcus in 10 patients, Staphylococcus in 5 patients, both Staphylococcus and Streptococcus in 1 patient, E. coli in 2 patients, and Candida in 1 patient. Indications for Surgery were congestive heart failure in 20, systemic emboli in 5, combination of both in 3, congestive heart failure with uncontrolled sepsis in 2, and complete heart block in 1 patient. Hospital mortality was 9.7% [3/31], and all were the patients who received emergency operation. There were 2 late mortality [7.7 %] due to acute myocardial infarction and recurrent endocarditis. This report suggests that the surgical treatment can be achieved with acceptable low mortality and morbidity in medically intractable congestive heart failure, emboli and sepsis.

• Journal of Yeungnam Medical Science
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• 제34권1호
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• pp.140-145
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• 2017

Glomerulonephritis (GN) is sometimes associated with infective endocarditis (IE). Bartonella endocarditis is difficult to diagnose because it is rare and cannot be detected by blood culture. This is the first report of cytoplasmic anti-neutrophil cytoplasmic antibody-positive subacute endocarditis-associated GN caused by Bartonella infection in South Korea. A 67-year-old man was hospitalized due to azotemia. He complained of weight loss and anorexia for 6 months. A diagnosis of IE was made based upon echocardiographic detection of vegetations on the mitral and aortic valves and a Bartonella antibody titer of 1:2,048. Renal histology identified focal crescentic GN. Azotemia and proteinuria improved after doxycycline and rifampin treatment combining with steroid therapy.

• Journal of Chest Surgery
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• 제36권4호
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• pp.273-276
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• 2003

좌심실 가성류로 내원한 39세 남자 환자에 대한 수술 치험 예를 보고하고자 한다. 환자는 4년 전 판막륜 농양을 동반한 감염성 심내막염으로 기계판막을 이용한 대동맥판막 및 승모판막 치환술과 농양 제거수술을 받았다. 수술 후 시행한 심초음파 소견상 좌심실과 농양이 있던 공동 사이에 교통이 있음이 관찰되었고, 추적 관찰 심초음파 검사에서 점차 공동의 크기가 증가하였다. 수술은 심페바이패스와 심정지하에 대동맥판막-승모판막 섬유연속부에 위치한 가성류와 좌심실 사이의 결손을 첩포폐쇄하였다. 수술 후 경과는 양호하였으며 수술 후 9일째에 합병증 없이 퇴원하였다.

• Investigative Magnetic Resonance Imaging
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• 제20권2호
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• pp.114-119
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• 2016

We report a case of vegetation in a 4-year-old female with infective endocarditis, diagnosed by late gadolinium-enhanced (LGE) cardiovascular magnetic resonance (CMR) imaging. The patient had a history of primary closure for ventricular septal defect and presented with mild febrile sensation. No remarkable clinical symptoms or laboratory findings were noted; however, transthoracic echocardiography demonstrated a 14 mm highly mobile homogeneous mass in the right ventricle. On LGE CMR imaging, the mass showed marginal rim enhancement, which suggested the diagnosis of vegetation rather than thrombus. The extracellular volume fraction (${\geq}42%$) of the lesion was higher than that of normal myocardium. Based on the patient's clinical history of congenital heart disease and pathologic confirmation of the lesion, a diagnosis of infective endocarditis with vegetation was made.

• Journal of Chest Surgery
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• 제21권1호
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• pp.121-130
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• 1988

During one year period from Sep. 1986 to Sep. 1987, we have experienced 6 cases of infective endocarditis requiring surgical interventions. All 6 patients had class IV or V cardiac disability at the time of surgery. The indication for surgery was rapidly progressive congestive heart failure in all cases. Four patients underwent aortic valve replacement including one double valve replacement. Two other patients required other surgical procedures, removal of large left atrial vegetation mass in one patient and excision of destroyed pulmonary valve and aortic vegetation in the other patient. Two patients died; one of mitral annulus rupture after release of aortic clamp and the other of mediastinal bleeding 3 months after replacement of aortic valve. Three out of 4 survivors are in NYHA Class I and the remaining patient is in Class II. We emphasize that early operative intervention is life-saving in patients with persistent or progressive congestive heart failure, irrespective of the activity of the infective process or the duration of antibiotic therapy.

• Journal of Chest Surgery
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• 제46권4호
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• pp.285-288
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• 2013

Prosthetic valves are being widely used in the treatment of heart valve disease. Prosthetic valve endocarditis (PVE) is one of the most catastrophic complications seen in these patients. In particular, prosthetic valve dehiscence can lead to acute decompensation, pulmonary edema, and cardiogenic shock. Here, we discuss the medical management of late PVE in a patient with a prior history of late and redo early PVE and recurrent dehiscence. According to the present case, we can summarize the learning points as follows. A prior history of infective endocarditis increases the risk of relapse or recurrence, and these patients should be evaluated very cautiously to prevent late complications. Adequate debridement of infected material is of paramount importance to prevent relapse. A history of dehiscence is associated with increased risk of relapse and recurrent dehiscence.