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European Heart Journal 1987 8(5):464-470;
Copyright © 1987 by the European Society of Cardiology.
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© 1987 The European Society of Cardiology

Early cardiac valve replacement in infective endocarditis; a 10-year experience

H. SURYAPRANATA, J. ROELANDT, M. HAALEBOS, J. DEGENER, E. BOS and P. G. HUGENHOLTZ

Thoraxcenter, Erasmus University Hospital, Rotterdam, and the Interuniversity Cardiology Institute The Netherlands

Received 23 May 1986; revised 17 October 1986; .

H. Suryapranata, M.D., The Thorax-center. Erasmus University, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.

Abstract

Thirty one patients underwent early valve replacement for infective endocarditis during a 10-year period (between September 1973 and December 1983). Intractable heart failure, persistent infection and systemicemboli were the indications for urgent surgical intervention. Native valve endocarditis had been present in 22 patients (71%) and surgery was performed 14–105 (mean 51) days after the onset of symptoms. Nine patients (29%) had prosthetic valve endocarditis and surgery was performed within 6 to 51 (mean 28) days. The aortic valve was replaced in 22 patients (71%), the mitral valve in 5 patients (16%) and both valves in 4 patients (13%). Four patients (12.9%) died during hospitalization. There were no late deaths or reinfection in this series. The remaining 27 patients were discharged and after a mean follow-up period of 36 months, 25 patients were in NYHA functional class I or II. Only 9 patients (29%) underwent cardiac catheterizaiion prior to surgery and the other patients were operated upon on the basis of echocardiographic data alone.

The post-operative results with a survival rate of 87%, justify an aggressive surgical approach in order to prevent serious complications and cardiovascular deterioration. It appears that surgical decision-making can be made on the basis of echocardiography. The risk of cardiac catheterization can be avoided with the newer generation of echocardiographic equipment which allows a detailed and complete analysis of cardiacabnormalities and function.

Key Words: Cardiac surgery • valve prostheses • echocardiography


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