Tehran University Medical Journal

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Two factors changed the clinical course of infective endocarditis dramatically: 1) The discovery and evolution of techniques for identifying and treating its microbiologic causes and 2) Valvular surgery. We retrospectively evaluated 43 (33.5%) patients (8 female, 35 male) from 4 to 65 years old of 128 patients with infective endocarditis who underwent surgical intervention. Indication for surgery were: Refractory congestive heart failure 14 (32.5%), prosthetic valves 10 (23.2%), large vegetation 6 (13.9%), recurrent endocarditis 4 (9.3%), ring abscess 4 (9.3%), brucella endocarditis 2 (4.6%), staph aureus endocarditis 3 (6.9%) and recurrent emboli 2 (4.6%). 30 to 50% of patients with infective endocarditis are operated during the active phase of the disease, this percentage is higher in case of aortic valve endocarditis, prosthetic valve endocarditis, some microorganisms such as staph aureus, gram negative bacilli, fungus and brucella. We suggest that internists refer patients for surgical intervention with infective endocarditis as early as possible in the active stage of infection.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Surgical methods for treatment of tricuspid valve (TV) endocarditis include repair, replacement and partial or complete exicion. The aim of this study was to assess the results of these different techniques.
Methods: Sixty seven patients were enrolled in this retrospective study. This study was carried-out between April 1997 and July 2007 in Imam Khomeini hospital. Decision of methods of choice for surgery was according to intraoperative findings.
Results: The mean age was 25.52±7.35 years and 74.36% were male. The most common bacteria was Staphylococcus areus (62.30%). Most of patients (74.60%) were IV drug abuser. The most common treatment modality was TV reconstruction (56.72%) and after that was TV replacement (29.85%) and the last one was complete TV excision (13.43%). Eight patients (11.94%) needed emergent TV replacement. The morbidity rate was 28.36% and the mortality rate was 13.51%. Thirty seven patients were followed. In follow-up period it was shown that postoperative Ejection Fraction (EF) and End-Diastolic Right Ventricle Diameters (EDRVD) values did not differ from preoperative values, but Pulmonary Artery (PA) pressure and Tricuspid Regurgitation (TR) severity were significantly lower compared with preoperative values. The postoperative function class did not show any changes compared with peroperative values.
Conclusion: Considering the specific epidemiology of patients with infective endocarditis, who are suffering from TV regurgitation, in some patients, it would be better to consider replacement instead of repair. This could be due to sever deformities and diffuse damage of TV leaflets from infection in our patients.