Related Experiment Videos
Surgical treatment of infective endocarditis complicated by annular infection and cerebral infarction
1Division of Cardiovascular Surgery, Hyogo Brain and heart Center, Himeji, Japan.
Insights
Early surgical intervention for infective endocarditis (IE) is crucial for patients with annular infection or cerebral infarction. Prompt valve replacement surgery significantly improves outcomes, reducing mortality and severe complications.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Neurosurgery
Background:
- Infective endocarditis (IE) can lead to severe complications like annular infection and cerebral infarction.
- These complications significantly increase mortality and morbidity.
- Optimal timing and surgical approach for IE with these complications remain critical.
Purpose of the Study:
- To describe the surgical treatment outcomes for patients with IE complicated by annular infection.
- To evaluate the results of valve replacement in patients with IE and cerebral infarction.
- To emphasize the necessity of early surgical intervention in complex IE cases.
Main Methods:
- Surgical débridement and valve replacement (original, supraannular, or translocation) for annular infections.
- Valve replacement for IE with cerebral infarction, performed at varying intervals post-infarction.
- Case series analysis of surgical outcomes and patient recovery.
Main Results:
- For annular infections, supraannular or translocation procedures had higher mortality compared to original position replacement.
- Valve replacement for IE with cerebral infarction showed favorable outcomes in most patients, even with mycotic aneurysms.
- Early surgery demonstrated reduced mortality and morbidity associated with IE sequelae.
Conclusions:
- Early surgical treatment for infective endocarditis is mandatory, regardless of active infection status.
- Prompt surgical intervention is vital to mitigate high mortality and morbidity from complications like annular abscess and cerebral infarction.
- Surgical strategy for IE with annular involvement should prioritize the original valve position when feasible.
Abstract:
The surgical treatment of nine patients with infective endocarditis (IE) complicated by annular infection and five with IE complicated by cerebral infarction is described herein. In those with annular infection, after thorough débridement of the infected tissues, valve replacement was performed at the original position in five, at the supraannular position in three, and one underwent a translocation procedure. Aortic valve replacement was able to be performed at the original position in two patients by closing the defect at the aortic annulus with a patch after through débridement. The five patients who underwent original valve position replacement recovered well. Of the three who underwent supraannular position replacement, two died of septicemia after a redo operation, and one received pacemaker implantation. The patient undergoing the translocation procedure died of intestinal infarction. In the five patients who suffered cerebral infarction due to embolus of the vegetation, valve replacement was performed between 40 h and 5 months after its onset. Although one patient died of the rapid progression of brain damage, the other four are alive and well, including two who developed mycotic cerebral aneurysm in the infarcted areas. In conclusion, early surgery for IE is mandatory irrespective of active infection, due to the high mortality and morbidity associated with serious sequelae such as annular abscess or cerebral infarction.