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European Heart Journal 1995 16(Supplement B):39-47; doi:10.1093/eurheartj/16.suppl_B.39
Copyright © 1995 by the European Society of Cardiology.
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© 1995 The European Society of Cardiology

Late prosthetic valve endocarditis

D. Horstkotte, C. Piper, R. Niehues, M. Wiemer and H. P. Schultheiss

Department of Cardiology, University Hospital Benjamin Franklin Berlin, Germany

Correspondence: Dr med D. Horstkotte, Department of Cardiology, University Hospital Benjamin Franklin, Free University Berlin, Hindenburgdamm 30, 12200 Berlin, Germany.

Prosthetic valve endocarditis remains an extremely serious complication, with a low but increasing incidence. ‘Late’ endocarditis, occurring more than 60 days after surgery, is relatively infrequently associated with staphylococci, Gram-negative bacteria and fungi so characteristic of the endocarditis that occurs earlier.

A probable source of infection can be found in 25%–80% of patients, the most frequent causes being dental procedures, urological infections and interventions, and indwelling catheters. The most common organisms are S. epidermidis, S. aureus, viridans streptococci and enterococci. The general principles of antibiotic treatment are similar to those for native valve endocarditis, but antibiotic treatment needs to be more prolonged and dosages should be used which result in maximal, non-toxic concentrations. Oral anticoagulants should be stopped and replaced by intravenous heparins.

Surgical reintervention is called for if there are large highly mobile vegetations in the mitral position or within 72 h if there are cerebral thrombo-embolic episodes.

Key Words: Heart valve prosthesis • endocarditis • endocarditis surgery • prosthesis related infection


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