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European Heart Journal 1985 6(5):380-390;
Copyright © 1985 by the European Society of Cardiology.
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© 1985 The European Society of Cardiology

Duration of symptoms and the effects of a more aggressive surgical policy: two factors affecting prognosis of infective endocarditis

P. NIHOYANNOPOULOS, C. M. OAKLEY, N. EXADACTYLOS, P. RIBEIRO, S. WESTABY and R. A. FOALE

Department of Clinical Cardiology, The Royal Postgraduate Medical School, Hammersmith Hospital London, U.K.

Received 6 February 1985; .

Address for reprints: Dr Celia M. Oakley, Department of Clinical Cardiology, Hammersmith Hospital, Du Cane Road, London W120HS, England

Abstract

One hundred and six patients were analysed in order to assess the effect of a more aggressive surgical policy in relation to the delays in diagnosis of infective endocarditis. The average duration of symptoms before diagnosis was 9.7 weeks, even though the patients had sought medical advice at a relatively early stage of their illness (2.2 weeks). Three of the 29 (10.3%) patients who were treated surgically died and all three were operated upon five weeks or later after diagnosis. Seventy-seven patients did not have surgery and 15 died (19.5%).

The outcome of surgical treatment for prosthetic valve endocarditis was no worse than for native valve endocarditis. The mortality of prosthetic valve endocarditis including early infections was 32% with medical but only 10% with surgical management compared with 14.5% and 10.5% in native valve endocarditis.Endocarditis cannot always be prevented but earlier diagnosis would reduce mortality and prevent complications. When medical treatment is failing then surgery should be considered early and urgently particularly in staphylococcal infection or when large mobile vegetations are recognized; surgery is mandatory in fungal endocarditis. Earlier diagnosis would greatly reduce the current high incidence of surgery, but that depends on a much heightened index of suspicion amongst both general practitioners and hospital physicians.

Key Words: Infective endocarditis • surgery • valvular prosthesis


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