Acute Forms of Infective Endocarditis – Indications for Emergency Surgery

Gennadiy Khubulava, Nazim Shikhverdiev, Andrey Peleshok, Dmitriy Ushakov, Vladimir Krivopalov, Valeriy Sizenko

Russian Military Medical Academy, Saint-Petersburg, Russia

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Introduction: In some cases in the acute course of infective endocarditis valve repair could be difficult due to therapid destruction of the intracardiac structures. 

Aim: to study the features of symptoms, management, diagnosis and treatment of infective endocarditis in modern life.

Materials and methods: The analysis of 50 clinical cases of acute infective endocarditis of the left chambers of the heart for the period from January 2012 to December 2015 was performed. Among them there were 32 men (mean age 43.5 years) and 18 women (mean age 38.0 years). Isolated aortic valve destruction took place in 26 patients, mitral valve - in 15, two valves - in 9 patients. Inhospital stay before surgery wasnt longer than 3 days. We found that that for the appearance of destructive changes on the valves of the heart was enough for 1-3 days. Indications for emergency surgery were: progressive heart failure (more common for aortic valve destruction), high risk for embolic complications, high chance of valve repair. Frequency of valve repair was 10%.

Results: Inhospital mortality was 8%. 4 patients died: 1 patient in tha age of 62 years died after posterior wall of left ventricular rupture after mitral valve replacement, 3 patients died after two valve replacement. Other complications that didn’t lead to death took place in 7 patients.

Conclusion: In severe cases of IE, antibiotic therapy without surgery practically has no chance of success, and unjustified prolongation of the operation can increase the number of complications. The possibility of such rapid destruction of intracardiac structures should be taken into account when indications for urgent interventions in acute infective endocarditis are determining. Delay with the surgical sanitation of the heart chambers reduces the chance of performing valve repair.