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[Recurrent infective endocarditis]
J P Delahaye1, T Beuchot, F Delahaye
1Hôpital cardio-vasculaire et pneumologique, BP Lyon-Montchat, France.
Abstract:
Between August, 1974 and May, 1987, 486 patients were treated for infective endocarditis. In 16 of these patients (12 men, 4 women, mean age 44.3 +/- 18.0 years at the time of the first episode) the endocarditis recurred: once in 14 patients, twice in 2 patients. The time elapsed between recovery from the first episode and onset of the recurrence varied from 6 to 159 months (mean 54.3 +/- 35.1 months). Among the 18 recurrences, 10 affected native valves (mitral 6, aortic 4) and 8 aortic prostheses. In all but one case the organism isolated during the recurrence (Streptococcus in 14 cases, Staphylococcus in 3 cases, Rickettsia in 1 case) was different from the organism responsible for the previous infection. The 16 patients were followed up for periods of 28 to 203 months (mean 107.0 +/- 58.0 months), counting from the onset of the first episode. Ten patients were treated medically during the second episode: 4 died and 2 had a second recurrence, lethal in one of them (time elapsed between the onset of the first episode and the date of death: 32 to 149 months). Six patients were operated upon (valve replacement in 5 cases, closure of a left aorto-ventricular fistula in 1 case) without deaths. Nine of the 11 survivors are now asymptomatic. The actuarial survival rate in recurrent endocarditis (75 p. 100, 10 years after the onset of the first episode) is not different from that observed in non-recurrent endocarditis.
Insights
Recurrent infective endocarditis occurred in 16 patients, often with different pathogens. Surgical intervention for recurrent endocarditis showed better outcomes than medical treatment, with similar survival rates to non-recurrent cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Clinical Medicine
Context:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Recurrence of IE poses significant management challenges.
- Understanding recurrence patterns is crucial for improving patient outcomes.
Purpose:
- To analyze the incidence, characteristics, and outcomes of recurrent infective endocarditis.
- To compare the efficacy of medical versus surgical management in recurrent IE.
- To assess the long-term survival rates in patients with recurrent IE.
Summary:
- This study reviewed 16 cases of recurrent infective endocarditis (IE) among 486 patients treated between 1974 and 1987.
- Recurrences typically involved different microorganisms than the initial infection and affected both native and prosthetic valves.
- Surgical treatment (valve replacement or fistula closure) resulted in no deaths, whereas medical management had a higher mortality rate.
Impact:
- Surgical intervention appears to be a safer and more effective treatment for recurrent infective endocarditis.
- The findings suggest that recurrent IE does not necessarily portend a worse long-term prognosis compared to initial episodes.
- This research informs clinical decision-making for managing complex IE cases.