The Annals of Thoracic Surgery, Vol 22, 464-472, Copyright © 1976 by The Society of Thoracic Surgeons
Surgical treatment of acute aortic regurgitation in infective endocarditis
V Krishnaswami, SP Reddy, EI Curtiss, JD O'Toole, JA Shaver and HT Bahnson
During a six-year period 15 consecutive patients with isolated aortic
regurgitation due to infective endocarditis were encountered. None had
prior significant aortic valve disease. Elective valve replacement was
performed in 13 patients; emergency operation was needed in only 1 patient
because of intractable pulmonary edema. One patient died suddenly from
acute heart block while undergoing medical treatment. Preoperative cardiac
catheterization studies in 10 of the 14 patients revealed gross elevations
of left ventricular end-diastolic pressure, pulmonary hypertension,
depressed cardiac output, and 3 to 4+ aortic regurgitation. There was 1
early and 1 late postoperative death, both due to systemic embolism,
yielding an overall surgical mortality of 14%. After a mean follow-up of 18
months, 10 of the 11 patients are in New York Heart Association Functional
Class I. Most patients with acute aortic regurgitation secondary to
infective endocarditis have clinically observable congestive heart failure
and will eventually require valve replacement. If congestive heart failure
can be stabilized by a medical regimen, a course of antibiotic therapy can
be administered and elective valve replacement can be performed. The time
taken for preoperative antibiotic treatment is not associated with
irreversible myocardial damage sufficient to influence the results of
operation.
