[HSF] Endocarditis with splenic infarct

[prasannasimha]

Butting in
Excise infective tissue and then decide.Active Vegetation size > 10 mm - 
go in early.
Mital AML perforation - patch
Commissural - excise both and Kay stitch closure and ring.(Even if 
kissing). Central kissing lesions - problem and may be difficult.
Chordal rupture - excise debride and Goretex neochordae or chordal 
transposition.
Mitral annular involvement - debride and use pericardial cuff  - TE David.
Preferably use Glutaraldehyde treated pericardium for the ring (more 
resistant)
You can tan edges (and sterilize them too) with Glutaraldehyde followed 
by a wash.It also helps while excising fistulous mushy tracts - you get 
a grip on it and allows good excision) I thik I sent a picture of it 
once long ago - can resend it if required.
At the end of the day - debride debride and debride - open abscesses and 
allow them to drain.
Then decide repair or replacement.
Fungus - life long antifungal and pray.
Embolus to brain - white - surgery. Hemorrhagic wait.
Aprotinin, Hemofilter (If you can get an AN 69 coated one better- I do 
not have it) and antibiotics as per culture.
Practical thing - if patients PT /INR is decreasing on Antibiotic 
therapy (before surgery) - he is responding and will be possible to wait.
Prasanna

erdinç naseri wrote:
> Hal,
> can you please elaborate on the choice of the repair versus replacement regarding the follwing parameters:1.Location of the vegetation:annular versus leaflet
> 2.Extense of the involvement:how many scallops,single leaflet versus bileaflet
> 3.Etiologic microrganism
> 4.Size of the vegetation
> 5.Peripheral embolization of the septic material
> 6.whatever else you consider in th e choice of surgical treatment.
> erdinc
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