Value and safety of cardiac catheterization during active infective endocarditis

Abstract

Cardiac Catheterization during active infective endocarditis is considered to be hazardous and, consequently, is often delayed. A review was made of experience with 35 patients who underwent Catheterization for severe heart failure (30 patients) and persistent sepsis or recurrent embolization (5 patients) in consideration of surgical intervention. The mean interval from hospital admission to Catheterization was 19 days, and 11 of 35 procedures were performed within 10 days of admission. Precatheterization clinical assessment was incomplete or incorrect in 23 patients. Cardiac Catheterization revealed clinically unsuspected multiple valve involvement in seven patients and documented single valve involvement in six patients with murmurs clinically suggestive of multiple valve endocarditis. In one patient thought to have mitral endocarditis, Catheterization localized the problem to the tricuspid valve. In six patients the study disclosed valve ring abscess and in three it provided anatomic definition of a left to right shunt associated with infection of a ruptured sinus of Valsalva. One additional patient was “cured” of infection by removal of a subclavian catheter fragment. The only complication encountered was transient atrial fibrillation. Catheterization-induced embolization and postcatheterization hemodynamic deterioration did not occur in these 35 patients. It is concluded that cardiac Catheterization yields invaluable hemodynamic and anatomic information and can be performed with minimal risk in patients with infective endocarditis who are being considered for surgery.