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INFECTIVE ENDOCARDITIS
Infective endocarditis is microbial infection of the endovascular structures of the heart.
It often presents in an occult fashion and early diagnosis depends on a high index of clinical suspicion especially in patients with congenital heart disease, prosthetic valves or previous infective endocarditis.
The established diagnosis of infective endocarditis is demonstrated by a positive blood culture and involvement of the endocardium detected during sepsis or systemic infection. It may also be established if there is involvement of the endocardium detected during sepsis or systemic infection but blood culture is negative.

Surgical Intervention

Principles of Surgical Treatment

  • Combined medical & surgical therapy for IE can decrease mortality among patients who have CHF, perivalvular invasive disease, or uncontrolled infection despite maximal antimicrobial therapy
  • The decision to perform surgery & its timing is dependent upon the cardiac & systemic complications caused by the infection, the microorganism’s virulence & the response to antimicrobial therapy
    • The optimal time to perform surgery is before severe hemodynamic disability or spread of the infection to perivalvular tissue occurs
  • CHF is the strongest indication for surgery in IE

Surgery should be considered in the following:

  • NVE patients w/ acute aortic or mitral regurgitation & CHF
  • Evidence of perivalvular extension
  • Persistent infection after 7-10 days of adequate antimicrobial therapy
  • Relapsing infection ie recurrence of bacteremia following a complete antibiotic course & subsequently negative BCs w/ no known source of infection
  • Infection w/ microorganisms that have poor response to antibiotic therapy (eg fungi, Brucella sp, Coxiella sp, Staphylococcus lugdunensis, Enterococcus sp w/ high-level resistance to Gentamicin, gram-negative organisms)
    • Left-sided IE caused by S aureus, fungal, or highly resistant organisms
  • NVE patients w/ mobile vegetation >10 mm before or during the 1st wk of antibiotic therapy
  • Recurrent emboli despite appropriate antibiotic therapy
  • Obstructive or persistent vegetations
  • Early PVE
  • Hemodynamically significant prosthetic valve
  • IE complicated by annular or aortic abscess, destructive penetrating lesion, or heart block
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