Review of one hundred and thirty-four patients with infective endocarditis with special reference to surgical management.

Abstract

The purpose of this paper is to review a total of 134 patients suffering from infective endocarditis (IE) and to outline some important aspects of this disease from the surgical management point of view. A total of 134 patients diagnosed as having IE during the past 6 years forms the basis of this report. Among them 36 patients had previous cardiovascular surgery prior to the onset of IE. The remaining 98 patients had no cardiovascular surgery. The surgery and autopsy study revealed a variety of underlying heart diseases in 62 out of 134 cases. There were acquired rheumatic valvular diseases in 16 patients (26%) and congenital cardiac malformations in 30 children(48%). Among 98 patients without surgery, 38 were found to have been cured of IE. Twenty-six of these required surgical treatment. There were no surgical deaths. Sixty patients with active IE were hospitalized. Emergency surgery was performed on 6 of these 60 as a life-saving measure. Four could be cured successfully, but 2 expired in their early stage after surgery. The remaining 54 with active IE were initially treated medically. Five died from complications caused by IE. In the whole series of 134 patients, medical treatment alone showed high mortality rate of 17.9% (7/9% cases), while surgical intervention yielded a lower rate of only 5.51% (3/59 cases). The satisfactory surgical results obtained in the present study emphasize the need to establish a standardized decision tree for the surgical treatment of IE. Our decision tree, used since 1981, was proposed.