Document Detail

Are high-velocity tricuspid and pulmonary regurgitation endocarditis risk substrates?
MedLine Citation:
PMID:  9665227     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: A major predisposing cause of infective endocarditis is a susceptible cardiac substrate characterized by high-velocity turbulent flow. However, the risk incurred by high-pressure, high-velocity regurgitation across inherently normal pulmonary and tricuspid valves has not hitherto been examined. METHODS AND RESULTS: This study focused on 186 adult patients with congenital heart disease who had pulmonary vascular disease and inherently normal right-sided pulmonary and tricuspid valves. The observation period was approximately 1646 patient-years. Exclusion criteria were coexisting lesions that might have served as independent risk substrates for infective endocarditis. High-velocity turbulent pulmonary and tricuspid regurgitation were identified and quantified by color flow imaging and continuous wave Doppler echocardiography. Diagnoses of infective endocarditis were based on established clinical and laboratory criteria. Tricuspid regurgitation was moderate to severe in 80 patients and mild or absent in 106 patients. Pulmonary regurgitation was moderate to severe in 84 patients and mild or absent in 102 patients. With the exception of a single habitual intravenous drug abuser, no patient, irrespective of the degree of high-velocity turbulent pulmonary or tricuspid regurgitation, had infective endocarditis. CONCLUSIONS: High-velocity turbulent flow across inherently normal pulmonary and tricuspid valves rendered incompetent by pulmonary hypertension may represent a relatively low-risk or no-risk substrate for infective endocarditis.
H Dodo; J K Perloff; J S Child; P D Miner; D A Pegues
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  136     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1998 Jul 
Date Detail:
Created Date:  1998-07-29     Completed Date:  1998-07-29     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  109-14     Citation Subset:  AIM; IM    
Department of Medicine and the UCLA Adult Congenital Heart Disease Center, University of California, Los Angeles, USA.
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MeSH Terms
Aged, 80 and over
Blood Flow Velocity
Echocardiography, Doppler, Color
Endocarditis, Bacterial / diagnosis,  etiology*
Follow-Up Studies
Middle Aged
Pulmonary Valve Insufficiency / complications,  physiopathology*,  ultrasonography
Retrospective Studies
Risk Factors
Staphylococcal Infections / diagnosis,  etiology
Staphylococcus aureus / isolation & purification
Tricuspid Valve Insufficiency / complications,  physiopathology*,  ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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