TAILIEUCHUNG - Chapter 118. Infective Endocarditis (Part 11)

Intracardiac Surgical Indications Most surgical interventions are warranted by intracardiac findings, detected most reliably by TEE. Because of the highly invasive nature of prosthetic valve endocarditis, as many as 40% of affected patients merit surgical treatment. In many patients, coincident rather than single intracardiac events necessitate surgery. Congestive Heart Failure Moderate to severe refractory congestive heart failure caused by new or worsening valve dysfunction is the major indication for cardiac surgical treatment of endocarditis. Of patients with moderate to severe heart failure due to valve dysfunction who are treated medically, 60–90% die within 6 months. In this setting, surgical treatment improves. | Chapter 118. Infective Endocarditis Part 11 Intracardiac Surgical Indications Most surgical interventions are warranted by intracardiac findings detected most reliably by TEE. Because of the highly invasive nature of prosthetic valve endocarditis as many as 40 of affected patients merit surgical treatment. In many patients coincident rather than single intracardiac events necessitate surgery. Congestive Heart Failure Moderate to severe refractory congestive heart failure caused by new or worsening valve dysfunction is the major indication for cardiac surgical treatment of endocarditis. Of patients with moderate to severe heart failure due to valve dysfunction who are treated medically 60-90 die within 6 months. In this setting surgical treatment improves outcome with mortality rates of 20 in native valve endocarditis and 35-55 in prosthetic valve infection. Surgery can relieve functional stenosis due to large vegetations or restore competence to damaged regurgitant valves. Perivalvular Infection This complication which occurs in 10-15 of native valve and 45-60 of prosthetic valve infections is suggested by persistent unexplained fever during appropriate therapy new electrocardiographic conduction disturbances and pericarditis. Extension can occur from any valve but is most common with aortic valve infection. TEE with color Doppler is the test of choice to detect perivalvular abscesses sensitivity 85 . Although occasional perivalvular infections are cured medically surgery is warranted when fever persists fistulae develop prostheses are dehisced and unstable and invasive infection relapses after appropriate treatment. Cardiac rhythm must be monitored since high-grade heart block may require insertion of a pacemaker. Uncontrolled Infection Continued positive blood cultures or otherwise-unexplained persistent fevers in patients with either blood culture-positive or -negative endocarditis despite optimal antibiotic therapy may reflect uncontrolled infection and may .

• Y học thường thức
• Infective Endocarditis
• bệnh học và điều trị
• bài giảng bệnh học
• tài liệu học ngành y
• Harrisons Internal Medicine
• BMC Veterinary Research
• Aortic valve
• Erysipelothrix rhusiopathiae
• Cardiac arrhythmias
• Significant regurgitation
• Non bacterial thrombotic endocarditis
• Lung cancer
• Deep vein thrombosis
• Transthoracic echocardiogram
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