ABSTRACT
A diabetic patient was admitted to our hospital for infective endocarditis with acute purulent pericarditis and diabetic ketoacidosis. Echocardiography revealed attachment of vegetation to the chordae tendineae in the left ventricle and pericaridial effusion. The vegetation was enlarged and pendulated for a few days despite maximal antimicrobial therapy. Surgical resection was desirable to decrease the risk of embolic complications and cardiovascular collapse. We could not open the heart because of accumulation of purulent pericardial fluid, and right renal infarction was complicated. We believe that the immunocompromised and hypercoagulable state due to diabetes caused these conditions.
Subject(s)
Endocarditis, Bacterial/etiology , Hyperglycemia/complications , Pericarditis, Constrictive/etiology , Adult , Blood Glucose/metabolism , Echocardiography , Electrocardiography , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/microbiology , Follow-Up Studies , Humans , Hyperglycemia/blood , Hyperglycemia/immunology , Male , Pericardial Effusion/diagnosis , Pericardial Effusion/etiology , Pericardial Effusion/microbiology , Pericarditis, Constrictive/diagnosis , Pericarditis, Constrictive/microbiology , Severity of Illness Index , Staphylococcal Infections/diagnosis , Staphylococcal Infections/etiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Streptococcal Infections/diagnosis , Streptococcal Infections/etiology , Streptococcal Infections/microbiology , Streptococcus/isolation & purification , SuppurationABSTRACT
A computer simulation was carried out to investigate the influence of nonpulsatile left ventricular assistance on hemodynamics. A simulation circuit was constructed to represent the circulatory system. A source of current was added to denote the nonpulsatile blood pump. The left and right ventricles were replaced by variable compliances. Left heart failure was simulated by decreasing the amount of compliance change of the left ventricle. We introduced a pulsatility indicator (PI) to clarify the pulsatility characteristics in the hemodynamics; this PI was defined as the ratio of the pulse pressure (PP) to the mean aortic pressure (AoP). When nonpulsatile bypass flow increased, the mean AoP, tension time index (TTI), and diastolic pressure time index (DPTI) increased, and cardiac output, PP, and PI decreased. When assisted flow increased with the constant total flow rate, the mean AoP and DPTI changed little; the PP, TTI, and PI decreased, and the endocardial viability rate increased. The PI would be helpful in evaluating the effect of pulsatility.
