Embolic Complications in Infective Endocarditits

Abstract

Embolic complications caused by migration of vegetation are frequent and serious, and result in stroke and/or death. Echocardiography plays a key role in assessing embolic risk and patients with large vegetations are at high risk of embolism. Early diagnosis of infective endocarditis (IE) and prompt start of antibiotic therapy are essential for preventing embolic complications of IE because the incidence of embolic events markedly decreases after appropriate antimicrobial therapy. Early surgical removal of vegetation may also reduce embolic complications in patients at high embolic risk. Role of early surgery has been expanding to prevent embolic complication and a recent randomized trial demonstrated that early surgery performed within 48 hours after the diagnosis of IE effectively reduced systemic embolisms without increasing operative mortality or recurrence of IE. Multidisciplinary collaboration between cardiologists, cardiac surgeons and infectious disease specialists is required for appropriate decision about indication and timing of surgical intervention, and the decision to perform surgery should be based on individual risk-benefit analysis.