HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hasan Sunar Enver Duran Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sunar, H. Articles by Duran, E. Search for Related Content PubMed PubMed Citation Articles by Sunar, H. Articles by Duran, E. Related Collections Related Articles

Ann Thorac Surg 2002;73:2036
© 2002 The Society of Thoracic Surgeons

---

Correspondence

Vegetectomy in brucella endocarditis

^a Department of Cardiovascular Surgery, Trakya University Medical Faculty, 22030 Edirne, Turkey

e-mail: hasansunar{at}trakya.edu.tr

To the Editor

We read with interest the article by Kele and colleagues on the treatment of Brucella endocarditis [1]. We agree with the authors that medical therapy alone is not sufficient in treating brucella endocarditis and best results are achieved by combining antimicrobial and surgical therapy. They report patients with complicated valvular lesions such as perforation or abscess that required valvular replacement with good results. Brucella endocarditis involves predominantly the aortic valve, and embolic phenomena are common features in addition to valve destruction and perivalvular abscess formation [2]. Valve replacement is usually preferred, however, in a small number of patients with endocarditis due to other microorganisms, simple excision of the vegetation "vegetectomy" has been reported as a conservative approach [3], if the valve is not destroyed or if there is no root abscess.

We reported a vegetectomy operation in a 19-year-old man with brucella endocarditis [4]. In our patient, the diagnosis of brucellosis was established serologically. He had a positive Wright’s tube agglutination test with a titer of 1/640 and a positive 2-mercaptoethanol test with a titer of 1/160. Transthoracic echocardiography revealed moderate aortic regurgitation and a vegetation 1 cm in diameter on the aortic valve. Four weeks after specific antimicrobial treatment (doxycycline, rifampicin, and trimethoprim plus sulfamethoxazole), surgical exploration revealed a single vegetation on an otherwise normal aortic valve. The aortic valve was competent after excision of vegetation. Antimicrobial therapy was continued for 9 months. Mild aortic regurgitation with no vegetation was detected after 2 years by echocardiography. Early operations combined with antimicrobial therapy before abscess formation and perforation of valve may save the native valve.

References

1. Kele C., Bozbua N., imanolu M., Güler M., Erdoan H.B., Akinci E., Yakut C. Surgical treatment of Brucella endocarditis. Ann Thorac Surg 2001;71:1160-1163.[Abstract/Free Full Text]
2. Bayer A.S., Bolger A.F., Taubert K.A., Wilson W. Diagnosis and management of infective endocarditis and its complications. Circulation 1998;98:2936-2948.[Free Full Text]
3. Hughes C.F., Noble N. Vegetectomy: an alternative surgical treatment for infective endocarditis of the atrioventricular valves in drug addicts. J Thorac Cardiovasc Surg 1988;95:857-861.[Abstract]
4. Duran E., Sunar H., Ege T., Canbaz S., Akata F., Özbay G. Excision of aortic vegetation in Brucella endocarditis. Asian Cardiovasc Thorac Ann 2001;9:59-61.[Abstract/Free Full Text]

This article has been cited by other articles:

				C. S. Hollenbeak, D. L. Morris, and M. C. Sinclair Is Off-pump Coronary Artery Bypass Graft Surgery Cost-Saving? Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2002; 6(4): 325 - 329. [Abstract] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Hasan Sunar Enver Duran Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sunar, H. Articles by Duran, E. Search for Related Content PubMed PubMed Citation Articles by Sunar, H. Articles by Duran, E. Related Collections Related Articles