Early endocarditis following open-heart surgery--importance of surgical treatment

Nine cases of proven early form of endocarditis occurred after open-heart surgery. Eight of these occurred after valve surgery with an incidence 0.7% while one complicated correction of Fallot's tetralogy. Sternal wound infection preceeded endocarditis in two cases and respiratory tract infection in one case. In these three patients, the infection was caused by the same bacteria as the subsequent postoperative endocarditis. In only one patient were there no signs of infection during the immediate postoperative course. A new cardiac murmur suggesting prosthetic malfunction was a clear indication for early reoperation in five patients; four of them survived. In one patient with a paravalvular leakage the decision to operate was delayed with fatal outcome. Generally, in patients without signs of prosthetic valve malfunction or other prosthetic complication the indication and timing of surgery is problematic. In our series the antibiotic therapy was continued over two months in three patients. Two of them died while the third patient was operated on successfully.