[HSF] Endocarditis with splenic infarct

[nand kejriwal]

Hal & Prasanna

*Did you consider repairing, rather than replacing the mitral valve?*

Yes, I did consider repairing the valve, but the positive gram staining put
me off. I thought the best chance the patient had was to get rid of all the
potential infected foci. Therefore, I removed the entire valve apparatus and
placed Gore-Tex chordae to restore the annulo-papillary continuity.

Bob & Prasanna

Needless to say the ID guys can describe a case with a 1.2 cm vegetation
that was finally sterilised without needing surgery My experience with
patients of this kind was that they often came to surgery eventually anyhow.
It is interesting that organisms were present in the vegetation. Did you
send any of it for culture?

Thanks for your comments. Yes, I sent the entire valve for culture. I am
awaiting the final results. Most likely, it will be the same organism.
Interestingly, I had a similar patient last week, who also had enterococcus
faecalis mitral endocarditis. He was in the hospital for 4 weeks on
antibiotics and was never referred for surgery. One fine morning he
developed a tender spot near the right wrist. An ultrasound revealed
occlusion of the right radial artery, most likely from embolic vegetation.
He also had kissing vegetations on the aortic valve and underwent double
valve replacement. Both these patients were lucky that the vegetations did
not embolise to the brain. I shall be talking to the cardiologists next week
to ensure that the surgeons are involved in the management of endocarditis
right from the beginning. I had to cancel my routine cases in both these
instances to accommodate their ill-managed cases.

Otto

the antibiotic treatment was shorter than ideal.

The patient was sent home with arrangements to complete full six weeks of
antibiotics. As long as the antibiotic course is completed, I do not think
it matters whether it is done in-hospital or as an outpatient.
Nand