| Title | Contribution of echocardiography and immediate surgery to the management of severe aortic regurgitation from active infective endocarditis. | | Author(s) | Sareli P, Klein HO, Schamroth CL, Goldman AP, Antunes MJ, Pocock WA, Barlow JB | | Source | Am J Cardiol 1986 Feb 15; 57(6):413-8. | | MeSH | Adolescent
Adult
Aortic Valve
Aortic Valve Insufficiency
Echocardiography
Endocarditis, Bacterial
Female
Heart Valve Prosthesis
Hemodynamic Processes
Humans
Male
Methods
Middle Aged
Mitral Valve
Mitral Valve Insufficiency
Preoperative Care
Time Factors
| | Abstract | The timing of surgery in patients with severe aortic regurgitation and left ventricular (LV) failure, particularly when associated with active infective endocarditis (IE), is of the utmost importance. From July 1982 to May 1984, 34 patients, aged 15 to 60 years, with severe aortic regurgitation underwent immediate (within 24 hours of diagnosis) aortic valve surgery. All patients were in New York Heart Association class IV for LV failure. Eighteen patients had right-sided heart failure. Decision for immediate surgery was based on the echocardiographic demonstration of diastolic closure of the mitral valve or of vegetations on the aortic valve. Premature closure of the mitral valve was demonstrated echocardiographically in 17 patients, 13 of whom had diastolic crossover of LV and left atrial pressure tracings recorded at surgery. IE of the aortic valve was confirmed at surgery in 29 patients, 27 of whom had vegetations on echocardiography. Seven patients required replacement of both aortic and mitral valves. Antibiotic therapy for IE was started immediately after blood cultures were taken and continued for 4 to 6 weeks postoperatively. The mortality rate within 30 days of surgery was 6% for the group as a whole and 7% for those with IE. Mean follow-up period for the 32 survivors was 10.6 months. There were 2 late deaths. No patient had periprosthetic regurgitation or persistence of endocarditis. Procrastination in referral for surgery of these extremely ill patients is not justified and is likely to be associated with higher risks of morbidity and mortality. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 3946256 |
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