[Heart surgery in acute bacterial endocarditis without preoperative heart catheterization. Long-term observation of 40 patients]

In 40 patients with acute bacterial endocarditis, the indication for cardiac valve replacement was established exclusively on the basis of the echocardiographic and clinical findings. The patients had an average age of 42 years and were under followup observation for an average of 2.2 years. The endocarditis involved the aortic valve 32 times, the mitral valve once, the tricuspid valve in two cases and the aortic and mitral valve together in five cases. In addition to the valve replacement, a ventricular septum defect and aneurysm of the ascending aorta had to be dealt with surgically in two cases each. The intraoperative and perioperative lethality was 2.5% (n = 1). The postoperative lethality was 12.5% (n = 5). In the surviving 34 patients, a recurrence of the endocarditis has not occurred up to now in any case. According to the NYHA classification, six of the surviving patients were to be classified as stage II and 28 as stage I, whereas stage III or IV had been present preoperatively in all cases. The postoperative echocardiographic investigation revealed a significant decrease of the left ventricular enddiastolic diameter (from 61 +/- 8 mm to 51 +/- 5 mm; P less than 0.001). In four cases, a slight insufficiency of the artificial valve could be detected. Reoperation was not necessary in any of these patients.