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Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis
Insights
Bicuspid aortic valve endocarditis predominantly affects young males, often presenting with severe complications like heart failure and requiring urgent surgery. Early diagnosis and intervention are crucial for improving outcomes in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Bicuspid aortic valve (BAV) is a common congenital heart defect associated with an increased risk of infective endocarditis.
- Native valve endocarditis (NVE) on a BAV presents unique challenges in diagnosis and management.
- Understanding the specific characteristics and outcomes of BAV endocarditis is essential for clinical practice.
Purpose of the Study:
- To analyze the clinical features, microbiological profile, complications, and outcomes of patients with bicuspid aortic valve endocarditis.
- To compare the presentation and management of BAV endocarditis with general NVE.
- To evaluate the diagnostic accuracy of echocardiography in detecting underlying BAV in endocarditis patients.
Main Methods:
- Retrospective analysis of 50 cases of bicuspid aortic valve endocarditis treated at St. Thomas' Hospital between 1970 and 1998.
- Inclusion criteria: patients with pathologically or clinically proven endocarditis on a bicuspid aortic valve.
- Data collection included patient demographics, clinical presentation, causative organisms, complications, treatment (surgical vs. medical), and mortality.
Main Results:
- Bicuspid aortic valve endocarditis constituted 12.3% of NVE cases, predominantly affecting young males (mean age 39 years).
- Viridans streptococci and staphylococci were the most common pathogens (72%).
- Common symptoms included fever (74%) and malaise (70%), with a higher incidence of dyspnea (36%) compared to general NVE. Serious complications were frequent (72% heart failure, 30% periannular abscesses), necessitating surgery in 82% of initial admissions.
- Overall mortality was 14%, with surgical mortality at 9%. Echocardiography detected the underlying bicuspid aortic valve in only 35% of pre-operative studies.
Conclusions:
- Bicuspid aortic valve endocarditis is a severe condition in young males, characterized by frequent complications and a high rate of surgical intervention.
- The study highlights a potential underdiagnosis of the underlying bicuspid aortic valve, even with echocardiography, emphasizing the need for heightened clinical suspicion.
- Effective management requires prompt surgical intervention and consideration of the underlying valvular anomaly in patients with infective endocarditis.
Abstract:
We analyzed 50 cases of bicuspid aortic valve endocarditis in patients who presented to St. Thomas' Hospital from 1970 through 1998. These represented 12.3% of the 408 cases of native valve endocarditis (NVE). All patients were male, and their mean age was 39 years. Forty-five of the 50 cases were pathologically proven; 47 were clinically definite according to the Duke criteria and 49 according to our modifications of the Duke criteria. Viridans streptococci and staphylococci accounted for 72% of cases. The prevalences of clinical features were similar to those seen in NVE: fever (temperature >/=38 degrees C, 74%) and malaise (70%), although dyspnea was more frequent (36%). There was a high incidence of serious complications (72% heart failure; 30% periannular abscesses). Surgery was required during the initial admission in 82% of cases. Overall mortality was 14%, and surgical mortality was 9%. Few patients knew they had a "heart condition," and a bicuspid aortic valve was detected in only 35% of echocardiograms performed before surgery.