Indication of cardiac surgery in infective endocarditis

From the 33 patients with infective endocarditis (IE) hospitalized in the 1st Clinic of Internal Diseases, Timişoara between 1981 and 1984, in 5 (4 men and one woman) ranging in age from 21 to 52 years (mean 38) cardiac surgery was indicated and aortic (3) and mitral (2) valve replacements were performed. Valve replacement was performed for: 1) rapid/slow progressive hemodynamic deterioration with intractable congestive heart failure associated with ruptured chordae on posterior leaflet of mitral value (1 case); perforated aortic cusp (1 case); 2) prosthesis endocarditis (1 case); 3) precocious recurrence of IE (1 case); 4) uncontrollable infections (1 case). Echocardiography was helpful in all the cases by permitting recognition and evaluation of the preexistent lesions, and by the supplying of characteristic vegetations (all echocardiographic findings were confirmed by open heart surgery). Likewise it proved an accurate method in assessing pre- and post-operative left ventricular performance. In conclusion it is considered that early valve surgery in IE is indicated in hemodynamic deterioration, prosthetic endocarditis or impossibility to control septicemia. Echocardiography is the most useful noninvasive method for the pre- and postoperative evaluation of the patients investigated.