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Published on: January 7, 2019
Valvular perforation in left-sided native valve infective endocarditis.
Khaled Bachour1, Hammam Zmily, Mohammad Kizilbash
1Division of Cardiology, Wayne State University, Detroit, Michigan, USA.
Clinical Cardiology
|December 17, 2009
Summary
Valve perforation in left-sided native valve infective endocarditis (LNVIE) is linked to worse outcomes, including higher mortality. Early surgery may improve survival in these complex cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Left-sided native valve infective endocarditis (LNVIE) can lead to mitral and aortic valve perforation.
- The prognostic significance of valve perforation in LNVIE is not well-established.
Purpose of the Study:
- To investigate the characteristics and outcome predictors of LNVIE complicated by valve perforation.
- To compare outcomes between patients with and without valve perforation.
Main Methods:
- Retrospective review of 123 patients with LNVIE from 1998-2005.
- Patients stratified into Group A (perforation) and Group B (no perforation) based on transesophageal echocardiography or surgery.
- Analysis of clinical characteristics, comorbidities, and mortality.
Main Results:
- Valve perforation (Group A) was associated with severe valvular insufficiency, higher rates of hemodialysis, and increased indications for valvular surgery.
- Group A had a significantly higher in-hospital death rate (31.9% vs. 15.8%).
- Among patients indicated for surgery, those undergoing surgery in Group A had improved survival compared to conservative management (16.7% vs. 71.4% mortality).
Conclusions:
- Valve perforation in LNVIE is associated with hemodialysis, severe valvular insufficiency, and increased morbidity and mortality.
- Early surgical intervention for valve perforation in LNVIE appears to be associated with improved survival compared to conservative management.
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