We present a report of a Gerbode's defect (left ventricular-right atrial communication) resulting from bacterial endocarditis in a 63-year-old man. Also presented is a brief overview of the literature and a possible preoperative echocardiographic diagnostic criterion relating to this unusual condition.
Rupture of the left ventricle after myocardial infarction results either in sudden death from cardiac tamponade or, when pericardial adhesions are present, in bleeding that is confined to a limited space, which gradually expands as the blood flows through a small communicating orifice under high pressure, forming a false aneurysm. In three such patients a false aneurysm of the left ventricle after myocardial infarction was successfully treated by operation. The interval from the initiating event to the time of surgery averaged 10 months. Two of the patients had pericarditis and all presented at some stage of the illness with tachyarrhythmias and cardiac failure. All the patients survived operation and have improved functionally. Because of the propensity of false aneurysms to rupture, early diagnosis and aggressive surgical treatment are recommended.Rupture of the heart as a complication of acute myocardial infarction is responsible for 5-13% of deaths after infarction. 1-3 While the incidence of true ventricular aneurysm after infarction is about 10%,4 the incidence of false aneurysm is not known. False aneurysms are characterised by the presence of a narrow neck and a wall containing fibrous tissue and laminated clot but no myocardial elements and they have a strong tendency to rupture.5 By contrast, the true aneurysm has a wide neck and its wall is formed by scattered myocardial elements.In
A questionnaire was sent to 120 United Kingdom cardiac surgeons to ask for information on their use of prophylactic antibiotics in adult cardiac surgical patients. Data on type and duration of antibiotic were specifically sought. The response rate was 91%. All respondents used prophylactic antibiotics: 32% used single agents (second and third generation cephalosporins were the most commonly used) and 68% used either two (89%) or three (11%) antibiotics in combination. The total duration of prophylactic antibiotic treatment was less than 48 hours for 89% of respondents. Single dose antibiotics were used by only 6%. The use of prophylactic antibiotics has changed in the past few years, with a trend away from combinations of antibiotics to single agents. The duration of use of antibiotics has shortened and the use of single dose agents has increased.
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