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[Chronic endocarditis on valve prosthesis. 6 cases]
Insights
Chronic endocarditis following intracardiac prosthesis implantation presents significant challenges, often involving multiple relapses and severe complications. Continuous bacteriostatic antibiotic therapy showed promise in managing persistent or relapsed cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Prosthetic Valve Endocarditis
Background:
- Intracardiac prosthesis implantation is associated with a risk of endocarditis.
- Chronic endocarditis, defined as infection lasting over one year, poses unique management difficulties.
Observation:
- This study reviewed six cases of chronic endocarditis occurring 6 months to 2 years post-valve replacement.
- Prosthetic materials included Starr-Edwards and Hancock valves, and an intracardiac patch.
- Common microorganisms involved were Streptococcus, Serratia, and Corynebacterium.
Findings:
- Patients experienced 2-5 relapses over 18 months to 5 years.
- Major complications included dysimmune syndrome, embolic events, and prosthesis disinsertion.
- Antibiotic therapy and surgery were employed, with recurrent disinsertion noted in surgical cases.
Implications:
- Chronic endocarditis after prosthesis implantation has a high complication rate.
- Continuous bacteriostatic antibiotics may be beneficial for persistent or relapsing infections.
- Further research is needed to optimize treatment strategies for this challenging condition.
Abstract:
Six cases of chronic endocarditis (more than 1 year duration) have been extracted from a series of 72 cases of endocarditis (delayed in 49) associated with intracardiac prosthesis observed over a 15-year period. In these 6 cases endocarditis developed 6 months to 2 years after valve replacement. The prosthetic material included 3 Starr-Edward's valves, 2 Hancock's valves and 1 intracardiac patch. The micro-organism isolated were Streptococcus in 3 cases, Serratia and Corynebacterium in 1 case each. The 18-month to 5-year course of the disease was marked by 2 to 5 relapses separated by long periods of apyrexia. The most significant complications were dysimmune syndrome (5 cases), embolic accidents (2 cases) and prosthesis disinsertion (4 cases). Five patients benefited from antibiotic therapy; 4 were operated upon with recurrent disinsertion in 2 cases. Two patients died, one of repeated disinsertion, the other of myocardial dysfunction. Bacteriostatic antibiotics were administered continuously to 3 patients whose endocarditis persisted or relapsed, with satisfactory results in two cases followed-up for more than 2 years.