[Clinical problems in surgical treatment for active infective endocarditis]

From October, 1982, to December, 1995, 22 patients with active infective endocarditis underwent surgical treatment. Of 22 patients, 12 patients (group P) demonstrated microorganisms on blood culture obtained at the operation and/or in the excised valve, and 10 patients (group N) showed acute inflammatory reaction in the excised valve microscopically. Operative mortality in group P was significantly higher than that in group N (50% versus 0%,p < 0.01). Especially in group P, five of six patients (83%) with uncontorolled infection for more than eight days died within 30 days of operation. This showed that prolonged preoperative periods of uncontrolled infection influenced the surgical outcome of active infective endocarditis. In conclusion, patients who do not promptly response to antibiotic treatment must be considered for early operation within seven days of the diagnosis of infective endocarditis to decrease operative mortality. The plasma level of CRP and definition of sepsis may be useful as indicators of uncontrolled infection.