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[Three cases of right-sided active endocarditis with multiple pulmonary infarction]
1Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|March 26, 1998
Summary
Surgical intervention for right-sided endocarditis is effective when antibiotic therapy fails, especially with complications like pulmonary infarction and hemorrhage. Prompt surgery leads to successful recovery and symptom resolution in patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Thoracic Surgery
Background:
- Right-sided infective endocarditis can present with severe complications, including pulmonary involvement.
- Co-existing cardiac defects such as ventricular septal defect (VSD), aortic regurgitation (AR), and tricuspid regurgitation (TR) can complicate the clinical picture.
Observation:
- Three patients with right-sided active endocarditis and multiple pulmonary infarctions were analyzed.
- Case 1 presented with VSD, AR, TR, and congestive heart failure; Case 2 with TR; Case 3 with VSD, TR, and patent ductus arteriosus.
- Infecting agents included alpha-Streptococcus (Cases 1 & 3) and Candida albicans (Case 2); antibiotic therapy was ineffective in Cases 2 & 3.
Findings:
- Two patients (Cases 1 & 3) developed pulmonary hemorrhage, resolving pre-operatively in Case 1 but persisting in Case 3.
- All three patients underwent successful surgical treatment for endocarditis.
- Post-operative recovery was successful, with patients discharged and remaining symptom-free.
Implications:
- Surgical intervention is crucial for right-sided endocarditis unresponsive to antibiotics.
- Worsening hemodynamics and recurrent pulmonary complications (infarction, hemorrhage) are critical indicators for surgical consideration.
- Early surgical management can lead to favorable outcomes and complete recovery in complex endocarditis cases.