[HSF] Endocarditis with splenic infarct

[rwmfglycar at aol.com]

Small point here but recognise that a veg in which well stained  organisms can be seen histologically does not always grow anything on culture. Organisms that can be seen do not always grow (despite the use of careful microbiologic techniques)
Bob


-----Original Message-----
From: prasannasimha <prasannasimha at gmail.com>
To: OpenHeart-L at lists.hsforum.com
Sent: Sun, 3 Jun 2007 6:47 am
Subject: Re: [HSF] Endocarditis with splenic infarct


Options depends on the intactness of the veil territory. 
 
If the veil is to be excised, excise P1 . Place a slide incision on the A1only if required and excise part of A1 if involved by a kissing lesion... Place a Kay type stitch on the annulus and exclude the P1. Evaluate the other areas Place a ring now. 
 
If the excised point is a wedge with the veil intact, eccentric imbrication of P1can be done just like a P2 plication or a pericardial patch and Goretex suspension of the patched area. 
If the veil is not intact then since their is no support in that area, a Kay type exclusion will be required. 
 
You will have to flexible in your approach. 
 
Healed vegetations behave like any other case recurrent endocarditis depends on residual MR and the inciting cause removal and patient education of SBE prophylaxis. (This would not be altered and in fact would be worse with a prosthetic valve). 
In active endocarditis recurrence is dependent on debridement and use of a pericardial strip annuloplasty is supposed to decrease chances of recurrent endocarditis though many use a prosthetic ring with success. In the setting of endocarditis (non-healed) I use the regular ring that I make of Goretex but will use a Glutaraldehyde treated Pericardial strip if there is active endocarditis. 
The last photo I had put up had healed vegetations which were in fact calcified and so I used a Goretex ring. Remember though that a healed vegetation can still have viable bacteria entrapped inside its core. 
Prasanna 
 
nand kejriwal wrote: 
> Hal 
> 
> Did you find any difference in recurrence of endocarditis in patients > whose 
> vegetation was +ve for organisms as compared to those with sterile veges. 
> 
> Hal & Prasanna 
> 
> If you have to excise the entire P1, what repair would you do - annulus 
> reconstruction, suturing P2 to A1 and annuloplasty? 
> 
> nand 
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