Kardiovaskuläre Infektionen

  • R.G. Holzheimer
  • Horstkotte D.
  • Kühl U.
  • Niebel J.
  • C. Piper
  • M. Wiemer
  • Horstkotte D.
  • U. Kühl
  • M. Wienner
  • C. Piper
Chapter

Zusammenfassung

Kardiale Infektionen können auf Endokard, Myokard oder Perikard beschränkt sein oder benachbarte Strukturen gemeinsam betreffen. Bei lokal unkontrolliert verlaufender Endokarditis greift der Infektionsprozess z. B. häufig auf das Myokard über (Endomyokarditis). Bei primärer Myokarditis finden sich klinisch, elektrokardiographisch und echokardiographisch regelhaft die Zeichen einer begleitenden Perikarditis (Perimyokarditis). Das klassische rheumatische Fieber ist typisches Beispiel einer gleichzeitigen immunologischen Entzündungsreaktion von Endo-, Myound Perikard (Pankarditis).

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Literatur

  1. Siehe S. 376.Google Scholar
  2. Siehe S. 376.Google Scholar
  3. Clemens JD, Horwitz RJ, Jaffe TC, Feinstein AR, Stanton BS (1982) A controlled Evaluation of the risk of bacterial endocarditis in persons with mitral-valve prolaps. N Engl J Med 307:776–781PubMedCrossRefGoogle Scholar
  4. Durack DT (1995) Prevention of infective endocarditis. N Engl J Med 332:38–44PubMedCrossRefGoogle Scholar
  5. Everett ED, Hirschmann JV (1977) Transient bacteremia and endocarditis prophylaxis: a review. Medicine 56:61–77PubMedGoogle Scholar
  6. Gersony WM, Hayes CJ, Driscoll DJ et al. (1993) Bacterial endocarditis in patients with aortic stenosis, pulmonary stenosis of ventricular septal defect. Circulation 87(Suppl 1): 121–126Google Scholar
  7. Glauser MP, Francioli P (1982) Successful prophylaxis against experimental streptococcal endocarditis with bacteriostatic antibiotics. J Infect Dis 146:806–810PubMedCrossRefGoogle Scholar
  8. Horstkotte D, Friedrichs E, Pippert H, Bircks W, Loogen W (1986) Nutzen der Endokarditisprophylaxe bei Patienten mit prothetischen Herzklappen. Z Kardiol 76:8–11Google Scholar
  9. Imperiale TE, Horwitz RJ (1990) Does prophylaxis prevent postdental infective endocarditis?. A controlled evaluation of protective efficacy. Am J Med 88:131–136PubMedCrossRefGoogle Scholar
  10. Niebel J, Häussinger K, Meister W, Held E (1985) Antimikrobielle Prophylaxe der bakteriellen Endokarditis. Dtsch Med Wochenschr 110:145–152PubMedCrossRefGoogle Scholar
  11. Strom BL, Abrutyn E, Berlin JA et al. (1998) Dental and cardiac risk factors for infective endocarditis. A population-based, case-control study. Ann Intern Med 129:761–770PubMedGoogle Scholar
  12. Van der Meer JTM, van Wyk W, Thompson J (1992) Efficacy of antibiotic prophylaxis for prevention of native-valve endocarditis. Lancet 339:135–139PubMedCrossRefGoogle Scholar
  13. Adam D, Gahl K, von Graevenitz H et al. (1988) Revidierte Empfehlungen zur Prophylaxe bakterieller Endokarditiden. In: Kommission für klinische Kardiologie der Dtsch Gesellschaft für Kardi ologie — Herz-und Kreislaufforschung (Hrsg) Z Kardiol 87:566–568Google Scholar
  14. Adler Y, Finkelstein Y, Guindo J et al. (1998) Colchicine treatment for recurrent pericarditis. Circulation 97:2183–2185PubMedGoogle Scholar
  15. Aretz HT (1987). Myocarditis: the Dallas criteria. Hum Pathol 18:619–624PubMedCrossRefGoogle Scholar
  16. Baljepally R, Spodick DH (1998) PR-Segment Deviation as the Initial Electrocardiographic Response in Acute Pericarditis. Am J Cardiol 81:1505–1506PubMedCrossRefGoogle Scholar
  17. Bisno AL (1981) Treatment of infective endocarditis. Grune&Stratton, New York.Google Scholar
  18. Boden WE, Sadaniantz A (1985) Ventricular septal rupture during ibuprofen therapy for pericarditis after acute myocardial infarction Am J Cardiol 55:1631–1632PubMedCrossRefGoogle Scholar
  19. Braunwald E (ed) (1997) Heart disease, 5th edn. Saunders, PhiladelphiaGoogle Scholar
  20. Bruss J, Jacobs LE, Kotler MN, loli AW (1992) Utility of transoesophageal echocardiography in the conservative management of prosthetic valve endocarditis. Chest 102:1886–1888PubMedCrossRefGoogle Scholar
  21. Chambers HF, Korzeniowski OM, Sande MH (1983) The National Collaborative Endocarditis Study Group: Staphylococcus aureus endocarditis: Clinical manifestations in addicts and nonaddicts. Medicine (Baltimore) 62:170–177Google Scholar
  22. Cormier B, Vitoux B, Starkmann C et al. (1990) Value of transoesophageal echocardiography. From a preliminary exprerience of 531 cases. Arch Mal Coeur Vaiss 83:23–29PubMedGoogle Scholar
  23. Daniel WG, Mügge A, Grote J et al. (1993) Comparison of transthoracic and transesophageal echocardiography for detection af abnormalities of prostetic and bioprostetic valves in the mitral and aortic positions. Am J Cardiol 71:210–215PubMedCrossRefGoogle Scholar
  24. Durack DT, Beeson PB (1978) Pathogenesis of infective endocarditis. In: Rahimtoola SH (ed). Infective endocarditis, pp 1–48. Grune&Stratton, New YorkGoogle Scholar
  25. Foster E, Schiller NB (1992) The role of transoesophageal echocardiography in critical care: UCSF experience. J Am Soc Echocardiogr 5:368–374PubMedGoogle Scholar
  26. Fowler NO (1991) Tuberculous pericarditis. JAMA 266:99–103PubMedCrossRefGoogle Scholar
  27. Freedman LR, Valone J (1979) Experimental endocarditis. Prog Cardiovasc Dis 22:169–180PubMedCrossRefGoogle Scholar
  28. Gravanis MB, Sternby NH (1991) Incidence of myocarditis. A 10-year autopsy study from Malmo, Sweden. Arch Pathol Lab Med 115:390–392PubMedGoogle Scholar
  29. Hauck AJ, Kearney DL, Edwards WD (1989) Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error. Mayo Clin Proc 64:1235–1245PubMedGoogle Scholar
  30. Horstkotte D (1992) Endokarditis. In: Hornborstel H, Kaufmann W, Siegenthaler W (Hrsg) Innere Medizin in Praxis und Klinik, Bd I. Thieme, Stuttgart New York, S 1295–1329Google Scholar
  31. Horstkotte D (1995) Mikrobiell verursachte Endokarditis: klinische und tierexperimentelle Untersuchungen. Steinkopff, DarmstadtGoogle Scholar
  32. Horstkotte D, Bircks W, Loogen F (1986) Infective endocarditis of native and prosthetic valves — the case for prompt surgical intervention?. A retrospective analysis of factors affecting survival. Z Kardiol 75(Suppl 2):168–182PubMedGoogle Scholar
  33. Horstkotte D, Schulte HD, Bircks W (1991) Factors influencing prognosis and indication for surgical intervention in acute native-valve endocarditis. In: Horstkotte D, Bodnar E. Infective endocarditis. ICR Publ., London pp 171–197Google Scholar
  34. Horstkotte D, Schulte HD, Niehues R, Klein RM, Piper C, Strauer BE (1993) Diagnostic and therapeutic considerations in acute, severe mitral regurgitation: Experience in 42 consecutive patients. J Heart Valve Dis 2:512–522PubMedGoogle Scholar
  35. Horstkotte D, Piper C, Niehues R (1994) Prognose und Nachsorge mikrobiell verursachter Endokarditiden. In: Gahl K (Hrsg) Infektiöse Endokarditis. Steinkopff, DarmstadtGoogle Scholar
  36. Horstkotte D, Weist K, Rüden H (1998a) Better understanding of the pathogenesis of prosthetic valve endocarditis — recent perspectives for prevention strategies. J Heart Valve Dis 7:313–5PubMedGoogle Scholar
  37. Horstkotte D, Piper C, Wiemer M, Arendt G, Steinmetz H, Bergemann R, Schulte HD, Schultheiß HP (1998b) Dringlicher Herzklappenersatz nach akuter Hirnembolie während florider Endokarditis. Med Klin 93:284–293CrossRefGoogle Scholar
  38. Kreuzpaintner G, Horstkotte D, Lösse B, Strohmeyer G (1991) Increased risk of bacterial endocarditis in neoplastic and chronic inflammatory lesions of the gastrointestinal tract. In: Horstkotte D, Bodnar E (eds) Infective endocarditis. ICR, London, pp 163–167Google Scholar
  39. Kühl U, Lauer B, Souvatzoglu M, Vosberg H, Schultheiß HP (1998) Antimyosin-scintigraphy and immunohistochemical analysis of endomyokardial biopsy in patients with clinically suspected myocarditis —Evidence of myocardial cell damage and inflammation in the absence of histological signs of myocarditis. J Am Coll Cardiol: 32:1371–1376PubMedCrossRefGoogle Scholar
  40. Kühl U, Noutsias M, Seeberg B et al. (1994) Immunohistological evaluation of myocardial biopsies from patients with dilated cardiomyopathy. J Heart Failure 9:231–245Google Scholar
  41. Kühl U, Noutsias M, Seeberg B, Schultheiss HP (1996) Immunohistological evidence for a chronic intramyocardial inflammatory process in dilated cardiomyopathy. Heart 75:295–300PubMedCrossRefGoogle Scholar
  42. Kühl U, Pauschinger M, Schultheiß HP (1997) Äthiopathogenetische Differenzierung der entzündlichen Kardiomyopathie. Internist 38:590–601PubMedCrossRefGoogle Scholar
  43. 1.
    Leport C, Horstkotte D, Burckhardt D and The Group of Experts of the International Society for Chemotherapy (1995) Antibiotic prophylaxis for infective endocarditis from an international group of experts towards a european consensus. Eur Heart J 16(Suppl B): 126–131PubMedGoogle Scholar
  44. Mann-Segal DDM, Shanahan EA, Jones B, Ramasamy D (1996) Purulent pericarditis: Rediscovery of an old remedy. J Thorac Cardiovasc Surg 111:487–488PubMedCrossRefGoogle Scholar
  45. McKinsey DS, Rutts TE, Bisno AL (1987) Underlying cardiac lesions in adults with infective endocarditis. The changing spectrum. Am J Med 82:681–687PubMedCrossRefGoogle Scholar
  46. Mercé J, Sagristà-Sauleda J, Permanyer-Miralda G, Soler-Soler J (1998) Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?. Am J Med 105:106–109PubMedCrossRefGoogle Scholar
  47. Moellering RC (1991) Treatment of endocarditis caused by resistant streptococci. In: Horstkotte D, Bodnar E (eds) Infective endocarditis. ICR, London, pp 102–109Google Scholar
  48. Moreno R, Villacastin JP, Bueno H et al. (1997) Clinical and Echocardiographic Findings in HIV Patients with Pericardial Effusion. Cardiology 88:397–400PubMedCrossRefGoogle Scholar
  49. Niebel J, Horstkotte D (1998) Endokarditis-Prophylaxe 1998 — was ist gesichert?. Z Kardiol 87:663–666PubMedCrossRefGoogle Scholar
  50. Oliva PB, Hammill SC, Talano JV (1994) Effect of definition of incidence of postinfarction pericarditis. Is it time to redefine postinfarction pericarditis. Circulation 90:1537–1541PubMedGoogle Scholar
  51. Osterberg L, Vagelos R, Atwood JE (1998) Case Presentation and Review: Constrictive Pericarditis. West J Med 169:232–239PubMedGoogle Scholar
  52. Report of a Working Party of the British Society for Antimicrobial Chemotherapy (1985) Antibiotic treatment of streptococcal and staphylococcal endocarditis. Lancet II: 815–817Google Scholar
  53. Richardson P, McKenna W, Bristow M et al. (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies (news). Circulation 93:841–842PubMedCrossRefGoogle Scholar
  54. Sanfilippo AJ, Picard MH, Newell JB et al. (1991) Echocardiographic assessment of patients with infectious endocarditis: Prediction of risk for complications. J Am Coll Cardiol 18:1191–9PubMedCrossRefGoogle Scholar
  55. Shansons DC (1991) Antibiotic treatment of endocarditis due to penicillin-sensitive streptococci. In: Horstkotte D, Bodnar E (eds) Infective endocarditis. ICR, London, pp 97–101Google Scholar
  56. Taelman H, Kagame A, Batungwanayo J et al. (1990) Pericardial effusion and HIV infection. Lancet 335:924PubMedCrossRefGoogle Scholar

Studien

  1. Grossi EA et al. (1985) A survey of 77 major infectious complications of median sternotomy: a review of 7,949 consecutive operative procedures. Ann Thorac Surg 40:214–223PubMedCrossRefGoogle Scholar
  2. Harbarth S et al. (2000) Prolonged antibiotic prophyalxis after cardiovascular surgery and its effects on surgical site infections and antimicrobial resistance. Circulation 101:2916PubMedGoogle Scholar
  3. Ivert T et al. (1991) Management of deep sternal wound infection after cardiac surgery — Hanuman syndrome. Scand J Cardiovasc Surg 25:111–117CrossRefGoogle Scholar
  4. Loop FD et al. (1990) Sternal wound complications after isolated coronary artery bypass grafting: early and late mortality, morbidity and cost of care. Ann Surg 49:179–187Google Scholar
  5. Milano CA et al. (1995) Mediastinitis after coronary artery bypass graft surgery. Risk factors and long-term survival. Circulation 92:2245–2251PubMedGoogle Scholar
  6. Ottino G et al. (1987) Major sternal wound infection after open heart surgery: a multivariate analysis of risk factors in 2,579 consecutive operative procedures. Ann Thorac Surg 44:173–179PubMedCrossRefGoogle Scholar
  7. Serry C et al. (1980) Sternal wound complications: management and results. J Thorac Cardiovasc Surg 80:861–867PubMedGoogle Scholar

Weiterführende Literatur

  1. Acinapura AJ et al. (1985) Surgical management of infected median sternotomy: closed irrigation vs. muscle flaps. J Cardiovasc Surg (Torino) 26:44344–44346Google Scholar
  2. Alam HB et al. (1999) Saphenous vein graft infection. A fatal complication of postoperative mediastinitis. Chest 116:1816–1818PubMedCrossRefGoogle Scholar
  3. Breyer RH et al. (1984) A prospective study of sternal wound complications. Ann Thorac Surg 37:412–416PubMedCrossRefGoogle Scholar
  4. Bryan AJ et al. (1992) Median sternotomy wound dehiscence: a retrospective case control study of risk factors and outcome. J R Coll Srg Edinb 37:305–308Google Scholar
  5. Clancy CJ et al. (1997) Candidal mediastinitis: an emerging clinical entity. Clin Infect Dis 25:608–613PubMedCrossRefGoogle Scholar
  6. Culliford AT et al. (1976) Sternal and costochondral infections following open-heart surgery: a review of 2,594 cases. J Thorac Cardiovasc Surg 72:714–726PubMedGoogle Scholar
  7. Demmy TL et al. (1990) Recent experience with major sternal wound complications. Ann Thorac Surg 49:458–462PubMedCrossRefGoogle Scholar
  8. Dunn EJ et al. (1990) Surgical implications of sclerosing mediastinitis. A report of six cases and review of the literature. Chest 97:338–346PubMedCrossRefGoogle Scholar
  9. El Oakley RM, Wright JE (1996) Postoperative mediastinitis: classification and management. Ann Thorac Surg 61:1030–1036PubMedCrossRefGoogle Scholar
  10. Fanning WJ et al. (1987) Delayed sternal closure after cardiac surgery. Ann Thorac Surg 44:169–172PubMedCrossRefGoogle Scholar
  11. Garrett HE, Roper CL (1986) Surgical interventions in histoplasmosis. Ann Thorac Surg 42:711–722PubMedCrossRefGoogle Scholar
  12. Gottlieb LJ et al. (1994) Rigid internal fixation of the sternum in postoperative mediastinitis Arch Surg 129:489–493Google Scholar
  13. Gur E et al. (1998) Clinical-radiological evaluation of poststernotomy wound infection. Plast Reconstr Surg 101:348–355PubMedCrossRefGoogle Scholar
  14. lyoda A et al. (1999) Descending necrotizing mediastinitis: report of a case. Surg Today 29:1209–1212CrossRefGoogle Scholar
  15. Kohman LJ et al. (1990) Bacteremia and sternal infection after coronary artery bypass grafting. Ann Thorac Surg 49:454–457PubMedCrossRefGoogle Scholar
  16. Lamesch P et al. (1997) Cervicale Oesophagusperforation nach ventraler Fusion der Halswirbelsäule. Chirurg 68:543–547PubMedCrossRefGoogle Scholar
  17. Lundell L, Liedman B, Hyltander A (2000) Emergency oesophagectomy and proximal deviating oesophagostomy for fulminant mediastinal sepsis. Eur J Surg 167:675–678Google Scholar
  18. Lutwick LI et al. (1998) Post cardiac surgery infections. Crit Care Clin 14:221–250PubMedCrossRefGoogle Scholar
  19. Machens A et al. (1998) Postoperative infection after transsternal thymectomy for myasthenia gravis: A retrospective analysis of 125 cases. Surg Today 28:808–810PubMedCrossRefGoogle Scholar
  20. Madden JE et al. (1970) Studies in the management of the contaminated wound. Am J Surg 119:222–224PubMedCrossRefGoogle Scholar
  21. Miller Jl, Nahai F (1989) Repair of dehisced median sternotomy incision. Surg Clin North Am 69:1091–1102PubMedGoogle Scholar
  22. Munoz P et al. (1997) Post surgical mediastinitis: a case controlled study. Clin Infect Dis 25:1060–1064PubMedCrossRefGoogle Scholar
  23. Murray PM and Finegold SM (1984) Anaerobic mediatinitis. Rev Infect Dis 6 Supp M: S123-S127Google Scholar
  24. Nahai F et al. (1989) Primary treatment of the infected sternotomy wound with muscle flaps: a review of 211 consecutive cases. Plast Reconstr Surg 84:434–441PubMedCrossRefGoogle Scholar
  25. Nishida H et al. (1991) Discriminate use of electrocautery on the median sternotomy incision: a 0.16% wound infection rate. J Thorac Cardiovasc Surg 101:488–494PubMedGoogle Scholar
  26. Oates E, Payne DD (1994) Postoperative cardiothoracic infection: diagnostic value of indium-111 white blood cell imaging. Ann Thorac Surg 58:1442–1446PubMedCrossRefGoogle Scholar
  27. Parisian Mediastinitis Group (1996) Risk factors for deep sternal wound infection after sternotomy: a prospective, multicenter study. J Thorac Cardiovasc Surg 111:1200–1207CrossRefGoogle Scholar
  28. Robicsek F (1997) Prevention of secondary hemorrhage in Hanuman syndrome (open mediastinal drainage J Cardiovasc Surg 38:601–603Google Scholar
  29. Robicsek F (2000) Postoperative sterno-mediastinitis. Am Surg 66:184–92PubMedGoogle Scholar
  30. Robicsek F et al. (1984) The value of thermography in the early diagnosis of postoperative sternal wound infections. Thorac Cardiovasc Surg 32:260–265PubMedCrossRefGoogle Scholar
  31. Rutledge R et al. (1985) Mediastinal infection after open heart surgery. Surgery 97:88–92PubMedGoogle Scholar
  32. Sargent LA et al. (1991) The healing sternum: a comparison of osseus healingwith wire rigid fixation. Ann Thorac Surg 52:490–494PubMedCrossRefGoogle Scholar
  33. Sarr MG et al. (1984) Mediastinal infection after cardiac surgery. Ann Thorac Surg 38:415–423PubMedCrossRefGoogle Scholar
  34. Shafazand S et al. (1999) Inhalational anthrax. Epidemiology, diagnosis, and management. Chest 116:1369–1376PubMedCrossRefGoogle Scholar
  35. Shafir R et al. (1988) Faulty sternotomy and complications after median sternotomy. J Thorac Cardiovasc Surg 96:310–313PubMedGoogle Scholar
  36. Skinner DB, Myerowitz PD (1981) Recent advances in the management of thoracic surgical infections. Ann Thorac Surg 31:191–198PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2004

Authors and Affiliations

  • R.G. Holzheimer
    • 1
  • Horstkotte D.
    • 2
  • Kühl U.
    • 3
  • Niebel J.
    • 4
  • C. Piper
    • 2
  • M. Wiemer
    • 2
  • Horstkotte D.
    • 2
  • U. Kühl
    • 3
  • M. Wienner
    • 2
  • C. Piper
    • 2
  1. 1.Zentrum für Chirurgie I, Klinikum KröllwitzMartin-Luther-Universität Halle/WittenbergHalleDeutschland
  2. 2.Universitätsklinik der Ruhr-Universität BochumKardiologische Klinik, Herz- und Diabeteszentrum NRWBad OeynhausenDeutschland
  3. 3.FU Berlin, Benjamin-Franklin-KlinikumAbt. für Kardiologie und PulmonologieBerlinDeutschland
  4. 4.Deutsche Klinik für DiagnostikWiesbadenDeutschland

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