AW: [HSF] SBE and the Indications for Surgery

[Tea Acuff]

And in any case "life long" will not be too long for that indication...may not often get to 6 weeks.
Tea


----- Original Message ----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Monday, February 5, 2007 7:36:55 PM
Subject: Re: AW: [HSF] SBE and the Indications for Surgery


I keep all patients with endocarditis on 6 weeks of Ab therapy.If fungal 
endocarditis is present - life long therapy is indicated.
Prasanna

Mitch Lirtzman wrote:
> May I respectfully ask a follow up question? I had a similar patient 
> with staph aortic endocarditis. No emboli. Severe AI w/o failure. 
> Decent sized vegetation. Blood cultures had become neg. on appropriate 
> therapy. AVR...bada bing, bada bum. Easy recovery. NOW...do we place 
> him on suppressive Abx? If so How long? BTW, I did, for 3 mos, just to 
> make myself feel better. The ID guy didn't commit to definitive 
> therapy. Thanks in advance for the lessons.
> Mitch LirtzmanAt 01:23 AM 2/5/2007, you wrote:
>> Ed,
>> I agree, most of this complicate cases have splenic embolus. We have 
>> made a
>> nice number of splenectomies on them. The mortality is very high when 
>> the
>> patients have already cerebral insult.
>> Roberto
>>
>> -----Ursprüngliche Nachricht-----
>> Von: openheart-l-bounces at lists.hsforum.com
>> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von Edward 
>> Bender
>> Gesendet: Montag, 5. Februar 2007 00:58
>> An: OpenHeart-L at lists.hsforum.com
>> Betreff: Re: [HSF] SBE and the Indications for Surgery
>>
>> Hal:
>> You know as well as anyone on this list that old literature poisons
>> current practice.  The classic indications for surgery are heart
>> failure, embolus, or uncontrolled sepsis.  These were developed in an
>> era of high mortality rates for valve surgery, not to mention valve
>> surgery in a septic patient in failure.  Current literature claims a
>> 10% embolic rate when a vegetation is 15mm or more diameter.  We also
>> know that there are silent emboli occurring more frequently.  I would
>> not right off this patient yet.  Get CT of abdomen (spenic embolus?),
>> aggressive antibiotics, rehab.  In a couple of weeks she may be
>> salvageable.  The family will probably do whatever you say, so be
>> careful.  If she does improve neurologically, proceed without waiting.
>> Also, be kind to your ID guy. He probably feels bad enough already.
>>
>> PS. I give kudos to you stamina under pressure Sunday night.
>>
>> Ed Bender, MD
>>
>> On Feb 4, 2007, at 4:38 PM, Hgrmd at aol.com wrote:
>>
>> > Dear Members,
>> >   About 3 months ago, I was asked to see an 80 yo fairly frail
>> > lady  with
>> > mitral staph SBE.  By the time I saw her, she was afebrile with mild
>> > leukocytosis.  The coronaries were normal by cath and the EF was
>> > 50%.   TEE revealed a 15
>> > mm vegetation on the posterior leaflet with moderate MR.   There
>> > were no
>> > overt signs of CHF.   A t the time I suggested surgery  based on
>> > the large
>> > vegetation.  I was all set to operate, when, on the day  before,
>> > the ID doc stepped
>> > in and emphatically stated that surgery was not  indicated.  He
>> > felt that
>> > sepsis appeared to be controlled with anitibiotics  alone and that
>> > there were no
>> > indications for surgery.  He also told that to  the patient and her
>> > son.  I
>> > backed off and let them have their way.
>> >   Last Friday, I was reconsulted on this patient.  She had
>> > represented with
>> > a large right hemispheric CVA.  She was now blind in the  left eye
>> > and unable
>> > to move the left side.  She's screwed.   Transthoracic echo now
>> > revealed
>> > severe MR with poor visualization of the  posterior leaflet. The
>> > family told me
>> > they wished they had listened to me.   The point is that large
>> > vegetations alone
>> > are current indications for surgical  intervention.  Anybody disagree?
>> > Hal
>> > _______________________________________________
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