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Ann Thorac Surg 1981;32:347-350
© 1981 The Society of Thoracic Surgeons

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Articles

Early Operative Intervention in Aortic Bacterial Endocarditis

From the Department of Cardiac and Thoracic Surgery and the Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN

^* Address reprint requests to Dr. Prager, Department of Cardiac and Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232

	Abstract

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Since 1974, 14 patients have required valve replacement for native aortic valve bacterial endocarditis at Vanderbilt University Medical Center. There were 7 male and 7 female patients ranging from 11 to 65 years old. Nine of the patients were less than 27 years old.

All patients had congestive heart failure as a complication of the bacterial endocarditis and were in New York Heart Association (NYHA) Functional Class III or IV. Two patients were seen initially with arrhythmias, 3 had episodes of septic emboli, and 1 patient was operated on immediately after sustaining a cardiac arrest. Echocardiogram was utilized in 9 patients, and cardiac catheterization was performed in 6 patients who were suspected to have concomitant mitral valve or coronary artery disease.

All patients were operated on within two weeks after the institution of antibiotic therapy, and there were no operative or early postoperative deaths. Preoperative blood cultures were positive in 13 patients, with streptococcus cultured in 6 patients and staphylococcus in 4. Escherichia coli and enterococcus were the other pathogens cultured. All patients received antibiotics intravenously for a total of six weeks.

There has been 1 late postoperative death, which occurred 2 months following operation in a patient with myocardial failure unresponsive to treatment. Two patients underwent reoperation, 1 because of a persistent aorto-right ventricular fistula and the second because of paraprosthetic aortic regurgitation. Nine patients are now in NYHA Functional Class I and 4 are in Class II.

	Footnotes

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Presented at the Twenty-seventh Annual Meeting of the Southern Thoracic Surgical Association, Nov 13-15, 1980, White Sulphur Springs, WV.

	References

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1. Kelson SR. Observations on the treatment of subacute bacterial endocarditis since 1939 Ann Intern Med 1945;22:75.
2. Florey MF, Florey HW. General and local administration of penicillin Lancet 1943;1:387.
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4. Wallace AG, Young Jr WG, Osterhart S. Treatment of acute bacterial endocarditis by valve excision and replacement Circulation 1965;31:450.[Abstract/Free Full Text]
5. Hurst JW, Logue RB. The Heart. Third edition. New York: McGraw-Hill; 1974. pp. 468.
6. Griffin FM, Jones G, Cobbs CG. Aortic insufficiency in bacterial endocarditis Ann Intern Med 1972;76:23.[Medline]
7. Mills J, Utley J, Abbot J. Heart failure in infective endocarditis: predisposing factors, course and treatment Chest 1974;66:151.[Medline]
8. Okies JE, Bradshaw MW, Williams T. Valve replacement in bacterial endocarditis Chest 1973;63:898.[Medline]
9. Richardson J, Karp R, Kirklin J, Dismukes W. Treatment of infective endocarditis: a 10-year comparative analysis Circulation 1978;58:589.[Abstract/Free Full Text]
10. Wilson W, Danielson GK, Giulioni E, et al. Valve replacement in patients with active infective endocarditis Circulation 1978;58:585.[Abstract/Free Full Text]
11. Young JR, Welton D, Raizner A, et al. Surgery in active infective endocarditis Circulation 60: Suppl 1979;1:1-77.
12. Manhas DR, Mohri H, Hessel EA, et al. Experience with surgical management of primary infective endocarditis: a collected review of 139 patients Am Heart J 1972;84:738.[Medline]
13. Stiles G, Friesinger G. Bacterial endocarditis with aortic regurgitation: implications of embolism South Med J 1980;73:582.[Medline]

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This Article Abstract 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 Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Prager, R. L. Articles by Bender, H. W. Search for Related Content PubMed PubMed Citation Articles by Prager, R. L. Articles by Bender, H. W., Jr.