Endocarditis - New realities
Keywords:
endocarditis, Duke endocarditis service, echocardiographyAbstract
Despfte a stable incidence of endocarditis (END) in recent years,the epidemiological features have changed. An increased incidence of right-sided heart disease has emerged, associated with an increasing incidenceof intravenous drug use.
Objective:A retrospective study in patients (Pts) wfth endocardftis, diagnosed using the Duke Endocarditis Service (DES) criteria, was carried out. Clinical and echocardiographic parameters were evaluated.
Population and methods: During the period of May 92 December 1995, 32 Pts (25 male and 7female, with a mean age of 32.5years), had definite diagnostic crite ria of END by DES. The clinical course and echocar diographic exams were evaluated. Epidemiologic aspects, presentation, aetiological agents, disease evolu tionduring hospitaladmission,complications and echocardiographic aspects were analyzed.
Results: All patients,exceptone were admitted with fever; 28 patients (27,5%) demonstrated no structural cardiac problem, 2 had congenital cardiac defects and 2 rheumatic valvular disease; 22 patients (68%) were intravenous (LV.) drug users. Staphylococcusaureus was the responsible aetiologlcalagent in 16 cases.
Eight patients experienced septic embolic complications (4 pulmonary, 2 splenic 1 digitaland 1cerebral), all patients were LV. drug users.
The endocarditis was localized to the tricttspid valve in 20 patients (63%), aortic valve in 8, mitral valve in 6 and the pulmonary valve in 1 patient. The majority had involvement of one cardiac valve only, 3 cases involved multiple valves. Vegetations were singular in 21 patients (66%) and multiple in 7 patients. There were 5 cases of major valvular regurgitation: 3 aortic, 1 mitrat 1 tricuspid and 1 aortic abscess with a shuntfrom the left ventricle to the right atrium Five patients (16%) required surgical correction, with good post-operative outcomes. There was one operative mortality.
TTE was diagnostic in31 patients (97%) and TTE was necessary in 4 patientsfor further evaluation namely persistent fever or hemodynamic compromise.
Conclusions: 1)- This study revealed a predominance of right-sided endocarditis in young LV. drug users without pre-existent tricuspid valvular disease, with a 25% incidence of septic embolization. St. aureus was tlie predominant bacterium cultured
2)-The inmal 1TE was diagnostic in all but one case. TTE was importantfor furtherevaluation in paüents with haemodynamic compromise oruncontrolled in fection.
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