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A case of primary infectious endocarditis with the lesion of mitral valve in a pregnant woman is reported The diseases was caused by meticillin-resistant Staphylococcus aureus. Special attention is given to inefficiency of beta-lactame antibiotics against this infection and beneficial effect of daptomycin therapy. This observation confirms literature data about high frequency of thromboembolic complications of S aureus-induced infectious endocarditis due to the production of various coagulases and von Willebrand factor-binding protein by these microorganisms. An increase of coagulation caused by S. aureus is mediated through activation of prothrombin, factor XIII, and fibrin-binding fibronectin. It requires prescription of direct thrombin inhibitor pradax that proved to yield good results in the treatment of our patient. It is concluded that infectious endocarditis in pregnant women is characterized by an atypical clinical picture due to impaired immunity associated with rapid progression of the process after delivery, high frequency of thromboembolic and DIC syndromes.

Comparative analysis of anamnestic, clinical, laboratory and instrumental data involved 106 patients with infectious endocarditis treated in S.P. Botkin City Clinical Hospital in 2000-2011 and 92 ones admitted in 1985-1977. The results give evidence of ongoing pathomorphosis of infectious endocarditis as is apparent from the growing number of male patients, increased frequency of primary cases and previous invasive or intravascular manipulations, thromboembolic complications including pulmonary thromboembolism, right heart chamber endocarditis. Over half of the patients are socially unadapted C-peptide level is of diagnostic value for the assessment of inflammation activity, precursors of natriuretic peptide can be used to detect preclinical and clinical stages of cardiac failure related to infectious endocarditis. There is correlation between severity of inflammation and myocardial dysfunction. Early surgical intervention in the absence of effect of combined antibacterial therapy improves prognosis. Morphological studies of inflammation-related changes in myocardium, destruction of cardiomyocytes, dystrophic processes, and fibrosis play an important role in the development of cardiac insufficiency and prognosis of infectious endocarditis.

Pulmonary disseminations are frequently encountered in the practical work of a multi-disciplinary hospital and require differential diagnostics by join efforts of specialists in different fields of medicine. The aim of this study was to estimate the frequency and clinical picture of these conditions. We analysed clinical records of 154 patients admitted to the department of pulmonology and intensive therapy. Most patients in need of intensive therapy (n=54) presented with disseminations of infectious origin, such as disseminated tuberculosis (32%), pulmonary problems associated with sepsis and infectious endocarditis (14%), HIV-associated disseminations (23%). Canceromatosis and idiopathic interstitial pneumonia occurred in 18 and 13% of the cases respectively. Patients in the department of pulmonology had pulmonary dissemination syndrome of unclear origin or no overt clinical symptoms (n=100). The leading cause of their disease was sarcoidosis (60%) and idiopathic interstitial pneumonia (20%). 27 patients had this syndrome associated with HIV/AIDS. Clinical examples and difficulties of early diagnostics of pulmonary dissemination syndrome are discussed with reference to underlying diseases (sepsis, infectious endocarditis, HIV/AIDS, Goodpasture's syndrome). Special attention is given to the management of this condition based at a multidisciplinary hospital.

The aim of this work was to study the clinical course and morphogenesis of infectious endocarditis in HIV-infected intravenous drug abusers. In this patients, endocarditis was an acute disease with high frequency of thromboembolic complications and ill-defined exudative component of the inflammatory reaction. Autopsies dated to 1993-2008 showed that neither the presence of morphological signs of early HIV infection nor chronic hepatitis C with minimal or moderate inflammation has an appreciable effect on the intrahospital mortality rate in these patients.

The aim of this study was to elucidate effects of systemic enzymotherapy on the clinical course of infectious endocarditis and the frequency of thromboembolic complications in drug addicts compared with controls. Another objective was to develop an optimal regime of enzymotherapy depending on the severity of the disease. Inclusion of wobenzyme in the combined treatment of infectious endocarditis permitted to accelerate the achievement of clinical improvement, normalize blood rheologic characteristics, reduce severity of intoxication and systemic inflammation, decrease the frequency of septic thromboembolia of the pulmonary artery.

The clinical course of infectious endocardities (IE) was followed in 112 patients admitted to the Botkin City Hospital in 2000-2007 with reference to the age and social structure of the pathology, its clinical symptoms, results of laboratory and instrumental analysis, strategy of antibacterial therapy, and outcome of the disease. The data were compared with those obtained in the previous period (1987-1955). He study demonstrated an increased number of men with IE (up to 65%) in the recent years and an almost two-fold rise in the incidence of primary endocardities. The frequency of thromboembolic complications also increased (from 34 to 69%) involving the pulmonary artery system (24%). The same refers to the number of patients with multivalvular lesions (2, 3 or 4 heart valves) and affected right cardiac chambers (28.4%). Shortcomings at various stages of the treatment of patients with endocarditis have been revealed.

Progressive growth of infectious endocarditis morbidity has been noted in the world during recent 10 years. Among secondary forms of endocarditis rate of congenital heart defects is 21%. According to data of M.K. Rybakova (2007) the highest risk of development of infectious endocarditis (74%) is noted on bicuspid aortic valve. We present a clinical case of the patient C. with bicuspid aortic valve, secondary infectious endocarditis of aortic and mitral valves complicated with multiple abscessing of valvular apparatus of the heart. The following operation was carried out: mitral valve replacement with mechanical prosthesis ON-X 27 - 29 with preservation of subvalvular structures of posterior mitral valve leaflet, and replacement of aortic valve with mechanical prostheses ON-X-23. Despite development of severe complications in the patient C the outcome of disease was favorable. After course of rehabilitation the patient returned to work.

Infective endocarditis (IE) in drug addicts is characterized by the involvement of the right heart with evolving septic pulmonary thromboembolism. Staphylococcus aureus is the causative agent of IE in 71.8% of cases. The specific feature of the course of IE in drug addicts is a relatively low hospital mortality rate (35.5%). The main cause of death was generalized infection with a developing multiple organ dysfunction. Pyonecrotic foci in the organs and tissues and septic vasculitis were histologically detected along with pronounced dystrophic changes. The presence of morphological signs of HIV infection at early stages, as well as viral hepatitis C do not affect mortality rates in drug addicts with IE.

The paper covers an investigation of 150 patients with infective endocarditis (IE), including 100 patients (aged 18 to 30 years old) with intravenous drug abuse as the main risk factor. This subgroup is characterized by an acute clinical course of IE, with tricuspid valve disorder in most cases and septic pulmonary embolism relapse in 72% of cases. Heart failure, multiple cardiac valvular disorder and focal lung destruction were found to be the main factors of unfavorable outcome. A relation between the size of vegetation on the heart valves and the mortality rate was established. At the same time, secondary immunodeficiency due to HIV-infection had no significant effect on the mortality rate in the group of drug addicts. More frequent cases of heart failure with systemic circulation embolism lead to higher hospital mortality in the group of patients with a subacute clinical course of IE. In elderly patients other concomitant pathology resulted in late IE detection and a high mortality rate.

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).

A total of 265 patients suffering from infective endocarditis (IE) were operated on at the Center of Cardiology and Cardiovascular Surgery. Of these, 20 patients presented with arterial embolism of the peripheral arteries of varying standing (from in-hospital episodes of embolism to 8 months). Embolism of the cerebral arteries was identified in 8 (3.0%) patients with IE. In 5 patients, an embolus was located in the orifice of the internal carotid artery. Three persons were diagnosed to have embolism of the intracranial arteries. Thromboembolism of the limb arteries was present in 12 (4.5%) cases. Active IE was diagnosed in 11 patients; in 9 cases, IE was in a stage of remission, Bivalvular mitralaortic disease was present in 4 patients; aortic disease was identified in 9 and mitral disease in 7 patients. In 3 patients with acute disorders of cerebral circulation arising from embolism of the carotid arteries and in 3 patients with progressive acute limb ischemia due to embolism of lower limb arteries, the operations were performed on an emergency basis. In these cases, two stage operations were undertaken. Five patients presenting with infective aneurysms of lower limb arteries and thromboembolism of the peripheral arteries with chronic lower limb artery ischemia underwent one stage operations. The first stage of operation consisted in resection of the infected vascular segment and an aneurysm, the second stage in correction of valvular heart disease. The outcomes of operations were regarded as satisfactory in all the cases. No complications or lethal outcomes were recorded in the postoperative period.

The authors have analyzed 139 patients with specific features of the clinical course of infectious pathology, massive and unusual destruction of the intracardiac structures, non-standard kinds of valvuloplasty. They required individualized strategy of diagnosing and operative treatment.

The paper presents clinical manifestations of infectious endocarditis (IE), its new clinical classification, diagnostic criteria, potentialities and limitations of echocardiography. General principles of management of patients with IE are considered. The management algorithm is given, which involves the initial assessment of these patients, empirical therapy, etiotropic chemotherapy (CT) regimens in streptococcal, staphylococcal, gram-negative, fungal endocarditis, and IE of unknown etiology. Possible complications due to IE (refractory heart failure, infection dissemination, thrombohemorrhagic syndrome, immune diseases, persistent fever) are described, which need supplementary treatment, particularly schemes for correction of hemostatic and immune disorders. Clinical and microbiological criteria are proposed for evaluating the efficiency of treatment for IE. The conditions showing a higher risk for the types of IE that require antibiotic prophylaxis and the criteria for choosing its regimen are given. New trends in the treatment of IE, such as shorter courses of antibacterial CT, stepwise antibacterial therapy (ABT), and parenteral ABT at home, are outlined.

A case of right and left ventricular myocardial infarction in infectious endocarditis of the aortic valve in an injected drug abuser is reported. The infarction was diagnosed only in autopsy. Diagnostic difficulties are discussed. The literature on the problem is listed.

Infectious endocarditis (IE) is mainly a surgical problem and requires an integration of efforts of specialists of different fields for its treatment. Successful treatment of this severe disease is to be based on the early diagnosis and early operation. So IE should be estimated as a surgical pathology and this nosological form must be included in all manuals on general surgery and studying infectious endocarditis must be included in the programs of training doctors at surgical series of lectures. Such interpretation of this question will change doctors' mentality and will lead to the earliest admission of the patient with this pathology to specialized cardiosurgical hospital and will allow to avoid severe disabling complications of IE, to increase the number of valve-saving operations and to improve prognosis in the treatment of this disease.

39 patients with acute infectious endocarditis were observed; of these, 28 patients had HIV infection at different stages of the disease. The specific features of the course of acute infectious endocarditis in HIV-infected patients were established. The severe course of acute septic endocarditis was observed in those patients whose parameters of the cell-mediated immune system (cells CD4+) were in the state of compensation or subcompensation. At different stages of HIV infection different clinical syndromes of infectious endocarditis prevailed. In patients with HIV infection the combined lesions of the heart valve apparatus were observed and mixed microflora was isolated from the blood more frequently. The development of acute septic endocarditis negatively affected the course of HIV infection and was manifested by a rapid decrease in the amount of CD4 lymphocytes.

The authors describe the results of valvulometry, traditional histological and cytological investigations of dissected valves of 1084 patients and an analysis of causes of aortal insufficiency as compared to the literature data for the last 80 years. The main causes of heart valve diseases are considered to be mesenchymal dysplasia and infective endocarditis.

Of 204 patients with infectious endocarditis (IE) treated in the hospital in 1980-2000, 43(21.2%) developed neurological complications. These were: ischemic stroke (72.1%), hemorrhagic stroke (9.3%), both (7%), abscess and subarachnoidal hemorrhage (2.3% for each), meningitis (7%), toxic encephalopathy (11.6%). Neurological complications of IE arose prior to treatment and within the first week of antibacterial therapy in 63% cases, more frequently in the left carotid territory. Neurological complications in IE debute manifested acutely, pareses were more frequent than paralyses, with elevated temperature, low hemoglobin and red cell levels, leukocytosis. MRT detected 8 +/- 4.6 foci in the brain, CT--2 +/- 1.1, on the average. Lethality of IE patients with neurological complications reached 58.1% and was significantly higher than in those without such complications (14.9%, p < 0.001). Overall acturial survival 1 year after the discharge from the hospital was 94.4%, 5-year survival--61.1%, 10-year survival--11%.

The authors observed 68 drug addict in-patients, who received treatment for the pneumonia at the Primorski Regional Clinical Hospital and Vladivostok Municipal Clinical Hospital No. 1. The article details the specific features of the pneumonia of these in-patients. It was distinguished the 3 groups of hospital patients with the following characteristic features: patients with the respiratory distress syndrome of the adults; patients with the primary infective endocarditis mainly with the damage of respiratory (right) heart; patients with non-specific pneumonia. The peculiarities of the clinical process with the X-Ray pictures of the disease were also presented. The article identifies the acute beginning of the disease; the strongly pronounced intoxication syndrome; the usual cases of the late going to hospital of those patients; the extensiveness of the damage; the occurrence of the following complications at the early stage: pulmonary destruction, exudative pleurisy, empyema; the long period of the disease process; the development of the extensive pulmonary fibrosis. It was identified the 33.7% lethality for these groups of in-patients, while the average lethality of the in patients treated for pneumonia was 3.3% for the same period of time. The complicated pneumonia process of young patients with the infective endocarditis with damages of respiratory (right) hearts let us suppose their drug addiction.

40 patients with infective endocarditis (IE) abusing intravenous drugs (heroin, opium surrogates) and 9 IE patients predisposed to heart diseases were examined by Duke diagnostic criteria. IE in drug abusers is characterized by acute course of the disease with affection of the intact valves of the right heart (97.5%) and septicemia provoked by high-virulent microflora (Staph. aureus in 65%). Drug abusers showed the following principal clinical syndromes of IE: thromboembolic (65%); septic with formation of acute DIC syndrome (75%), development of pyodestructive foci in the organs and polyorganic insufficiency (23.3%); acute circulatory insufficiency (37.5%); secondary nephropathy (100%). In IE abusers with predisposition to heart diseases IE ran subacutely in the presence of bacteriemia caused by low-virulent microflora (Strept. viridans in 11%) or in the absence of microbial growth in blood seeding (78%). High IE lethality in drug abusers (40%) is explained both by severe complications and concomitant diseases (viral hepatitis B and C, HIV infection, etc.).

The aim of the study was analysis of clinical and laboratory markers of non-infectious thrombotic endocarditis (NITE) to facilitate differential diagnosis with infectious endocarditis (IE). 20 NITE patients (8 males and 12 females, mean age 32.3 years) were included in the trial. They had primary antiphospholipid syndrome, secondary antiphospholipid syndrome in systemic lupus erythematosus, nodular polyarteritis, nonspecific aortic arteritis, paraneoplastic NITE in lung and stomach cancer. NITE was also diagnosed in patients with gout and ankylosing spondylarthritis. Clinical and laboratory findings allow to differentiate IE with NITE. The former is characterized by destructive valvular lesions registered at echo-CG, positive hemoculture and arterial embolism. As a rule, NITE is associated with antiphospholipid syndrome and manifests with arterial and venous thrombosis, thrombocytopenia, livedo and presence of antibodies to cardiolipins.

The authors summed up the main principles of performing anesthesia and artificial blood circulation in cardiosurgical interventions in 5 women with 20-27 week pregnancy. In pregnant women with progressing cardiac failure due to a heart disease, thrombosis of the cardiac valve prosthesis, acute infectious endocarditis with the altered valve, large size tumor of the heart with disturbed valve function an emergency operation must be performed under conditions of artificial circulation. Operative treatment is the only effective method for saving life of the mother and fetus. The proposed complex preoperative preparation, intra- and postoperative management of the patients are thought to be an effective method of supporting operations on the heart under conditions of artificial blood circulation in pregnant women. In order to prevent possible complications antioxidants should be included in the complex of anesthesiologic means. During operations with artificial circulation in pregnant women it is necessary to strive for performing normothermal perfusions with high volume velocities.

Aim: Analysis of results of treatment of infectious endocarditis (IE) with glucocorticosteroids in combination with antibiotics., Material and Methods: 128 IE patients received antibiotics (control group). Glucocorticosteroids were added to antibiotics in 44 IE patients (study group)., Results: Valvular replacement, congestive heart insufficiency, thromboembolic complications, suppression of cellular and humoral immunity occurred more frequently in patients of the study group., Conclusion: It was found that glucocorticosteroids affect IE negatively, especially in the dose 30 mg/day and higher. Glucocorticosteroids are indicated in allergic reactions to the antibacterial drugs, severe renal damage (proteinuria < 1 g/l), myocardial defects; contraindicated in non-eradicated IE causative agent, in recurrent IE.

Clinical course of infectious endocarditis (IE) was analysed for 43 intravenous drug abusers. 42 of them had primary IE, one patient--secondary. Acute course and high activity of the disease were registered in 86% of the patients. IE was provoked by Staphylococcus aureus (50%), Staphylococcus epidermidis 920%), Staphylococcus haemolyticus (11%), E. coli (8%), Pseudomonas aeruginosa (2%), Candida albicans (2%), mixed microflora (7%). Vegetations were detected on the tricuspid, mitral and aortic valves (52, 23 and 19%, respectively), on more than one valve (6%). Pneumonia, pleuricy, hydrothorax, enlargement of the liver, spleen, nephritis and anemia were found in 76, 44, 9, 100, 75, 70 and 88% of the patients, respectively. Cardiac failure aggravated the disease in half of the patients, lethality was 18%. Thus, IE in intravenous drug abusers is characterized by a primary form, acute active course, prevalent damage to the tricuspid valve, polyorganic involvement, high lethality. IE cure in such patients is feasible only in adequate antibacterial therapy, timely surgical correction and giving up drug abuse.

As many as 188 records of IE patients were studied as were 67 autopsies of deceased persons. Significant changes in the clinical course of IE were disclosed over the past 10-15 years versus previous 15: more prominent role of staphylococcal and gram-negative flora in the etiology of the illness, with microbial associations-caused IE cases having become more common. Diagnostic value of hemoculture did not appear to show much promise. The following items were found to be important risk factors for IE: prior viral and bacterial infection, invasive interventions, and chronic somatic diseases. There prevailed those IE forms having appeared on the intact heart valves in elderly persons and those at a mature age. In the course of the illness there tended to be more toxic and allergic manifestations, thromboembolic complications, and extensive vascular pathology.

Aim: To check practical feasibility of recommendations of prevention of infectious endocarditis (IE) and to provide more accurate figures on the occurrence of valvular lesions in working population., Materials and Methods: Subacute IE manifestations have been analysed in 10 patients of a general outpatient clinic. Echocardiograms of 6209 patients under 60 years of age were studied retrospectively., Results: In one-third of the patients IE developed in the presence of streptococcal and staphylococcal infection. In all the cases cardiac valve involvement was stated. In 4 cases changes in the valve were not accompanied my impairment of the valvular function. By echocardiography, valvular structure changes without valvular disease were detected 2.3 times more frequently that valvular disease. Difficulties presenting in outpatient IE prophylaxis are outlined., Conclusion: Advances in IE prevention will be achieved if echo-CG becomes a mandatory examination in the program of working population check-up, if early diagnosis of streptococcal ENT infection is made, if physicians of different specialties work as a team.

Aim: Study of blood clotting to evaluate hemostatic disorders in infectious endocarditis (IE)., Materials and Methods: The trial included 124 patients with IE (61 males and 63 females aged 15-70 years). Primary and secondary IE was in 38 and 62% of patients, respectively., Results: Clinically evident hemostatic disorders were observed in 93(74.2%) cases. They manifested as intravascular platelet activation with development of hypercoagulatory status and chronic DIC-syndrome., Conclusion: A differentiated approach is advisable to correction of thrombotic disorders in IE basing on the severity of blood coagulation impairment.

Great surgical aggression in operations on the heart and resulting immunodeficiency create prerequisites for the appearance and grave course of infectious complications. The authors have analyzed results of operative treatment of 100 patients with acquired valvular diseases. It has been established that low parameters of the resistance index of organism (RIO) before operation can be estimated as an unfavourable prognostic sign of the development of infectious complications. The RIO dynamics at the postoperative period in many aspects reflects the character of its course. RIO and the indices of the adaptation reaction show the degree of intoxication, make the clinical estimation objective, allow the assessment of efficiency of therapy and correction of medical prescriptions.

Aim: The analysis of echo-CG morphology of the mitral system in patients with uncomplicated mitral prolapse (MP) in the presence and absence of mitral regurgitation and in patients with severe complications., Materials and Methods: Echo-CG was made in 116 patients with MP: with uncomplicated (87) and complicated (29) MP, with infectious endocarditis (13), thromboembolism (6), congestive circulation failure (10). MP was diagnosed according to the standard criteria with visualization of the mitral valve from the parasternal approach., Results: Mitral picture is detailed for 87 MP patients. Classification of the degree of myxomatous degeneration is proposed. 17 MP patients were exposed to loading echocardiography. Exercise may provoke transitory mitral regurgitation. Mitral status has been analysed in patients with serious MP complications., Conclusion: The relationship may exist between MP complications, severity of myxomatous degeneration of the mitral valve and the presence of any kind of mitral regurgitation.

Some literature data are presented on the problem of cardiac surgery in patients with chronic renal insufficiency under regular hemodialysis and on the specificity of performing operations on such patients under conditions of artificial circulation. The authors describe their first experience of a one-step prosthezing of the aortal valve and plication of the dissecting aneurysm of the ascending part of the aorta in the patient receiving the regular hemodialysis during 5 years as well as the positive results of this original operation in dynamics of the first year of observations.

Clinicomorphological characteristics of glomerulonephritis in infectious endocarditis (IEGN) were studied in 62 patients (with samples of autopsy material being used in 52 instances). IEGN presents with dissaminated and focal proliferative alterations involving extracapillary and/or tubulointerstitial components, and is characterized by a broad variability of indices for proteinuria, hematuria and cylindruria. In diffuse prolipherative glomerulonephritis the degree of proteinuria and cylindruria appear to be significantly higher than in focal segmental proliferative glomerulonephritis, as is the incidence rate of development of renal insufficiency and its gravity.

Along with typical clinical symptoms in present-day infectious endocarditis atypical picture may arise: impairment of CNS and cardiac muscle with psychosis, arrhythmia, defective cerebral circulation, heart failure. In the absence of typical manifestations diagnosis of infectious endocarditis presents difficulties.

The paper analyzes the experience in treating 75 patients with cardiac abscesses of various sites. Abscesses complicated the natural history of infectious endocarditis in all patients. The clinical features of cardiac abscesses are shown to be related to the stage of the destructive process. Echocardiography, follow-up analysis of ECH, PhCG and overall clinical data are demonstrated to play a role in their diagnosis. The paper discusses the specific features of surgical intervention into the heart if abscesses are present. Out of 75 patients who have been operated on for abscessing infectious endocarditis, 53 have had an operation and survived.

Based on the clinical, instrumental and biochemical findings, out of 104 patients with septic endocarditis 11 (10.6%) were diagnosed to have myocardial infarction. It was provoked by coronary artery embolism, the covering of the coronary artery ostium by vegetation from the aortal cusp, a decrease of perfusion pressure in atherosclerosis stenosed coronary arteries because of marked insufficiency of the aortal cusp. In more than half the cases, the clinical picture of myocardial infarction was atypical, painless. Echocardiographic demonstration of the vegetations near the coronary artery ostium permits forecasting the possibility of its covering with vegetation, the threat of the occurrence of acute coronary insufficiency, which may appear an additional indication for heart valve replacement.