Malignant Solitary Fibrous Tumour of the Pleura: A Case Report and Review of the Literature

Abstract

Introduction: Infective endocarditis (IE) is a life threatening infection, requiring surgical intervention in around half of all cases. Recommendations regarding surgical management are, however, based on limited data. We aimed to investigate patient and bacterial characteristics as well as outcomes associated with surgically treated aortic valve IE in an Australian tertiary hospital. Methods: The study institution’s Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) database was searched for all patients who underwent aortic valve surgery with active IE between 2001 and 2011. Patients were excluded if other valves were affected. Additional data were obtained by reviewing medical records and investigation results. Results: There were 35 patients in this cohort, all of whom underwent aortic valve replacement. Mean age was 50 18 years, 86% (30/35) were male and 31% (11/35) had a history of IV drug use. There were 12 cases (34%) of Staphylococcus aureus (2/12 were MRSA), seven cases of viridans Streptococci (20%) and six cases of Enterococcus faecalis (17%) IE. Mean time from admission to surgery was 17 31 days. Overall 30-day mortality was 20% (7/35), three deaths occurred in patients with S. aureus infections (25% of S. aureus patients). Twelve operations were performed as an emergency procedure and five of these patients died within 30days of surgery (42%). Discussion: Surgery for active aortic valve IE is associated with substantial mortality, especially when performed as an emergency procedure. Staphylococcus aureus is the commonest causative bacteria in patients requiring surgery at our institution and has a high mortality rate.