[HSF] Endocarditis

[erdinç naseri]

Ajit,
There are very strict guidlines for the surgical traetment of IE ( be it elective or emergency) and in my opinion none of them exists in this patient.
1.TEE is very informative in these patients and she doesn't have any vegetation ( >10mm in left sided valves for surgical intervention).
2.Causative organism is S. viridans which is very ab responsive.
3.No CHF
erdinc
> From: damle at cableone.net> To: OpenHeart-L at lists.hsforum.com> Date: Sat, 16 Jun 2007 23:07:44 -0500> CC: > Subject: [HSF] Endocarditis> > I would like some advice on the surgical indications in this patient:> > > > 45 yr female, horticulturist, previously good health. Gradual insidious> onset of weight loss, malaise last 3 months. Known to be positive for Hep C.> She was found to have a right adnexial mass and a right lung lesion and> initially thought to be cancer. However, the adnexial mass is proved to be> benign and the lung mass benign too on PET scan. Echo 1 month ago showed> normal EF, severe narrow jet MR with prolapsed posterior laflet, no> vegetations. Some one a did a blood culture two weeks later, positive for> strep viridans. ID following, on antibiotics for 12 days, afebrile, normal> WBC, no fever, appetite better.> > > > Unfortunately had a left cerebral stroke 10 days ago. Sequential MRIs showed> most likely embolic event. Also small multiple other cerebral emboli of> various duration. These have small hemorrhagic foci. She was initially> aphasic, now improved a lot, still can not walk. TEE a week ago and> yesterday show no change, no vegetations. Clinically, no CHF, CXR clear, no> hypoxia.> > > > Has had numerous multispeciality consultations. ID and cardiologists are> recommending MV replacement for "removing the focus of infection". The> indication being recurrent emboli. I am dithering because:> > > > 1. Too early after cerebral infarcts. Could make them much worse> > > > 2. No CHF, no decompensation> > > > 3. Infection under control> > > > 4. At least on the TEE valve looks clean. She would be much better served by> a repair. Repairs have been done in MV endocarditis. If we are going to> repair and leave the valve in place, I do not see the urgency for doing it> now.> > > > My fear is, in spite of the benign TEE appearance, the valve leaflets are> actually infected and may be serving as a focus of recurrent thrombi.> > > > What do you think?> > > > Ajit Damle> > Fargo ND> > > > _______________________________________________> OpenHeart-L mailing list> > Send postings to:> OpenHeart-L at lists.hsforum.com> > To UNSUBSCRIBE, to CHANGE email address, or to view archives:> http://mmp.cjp.com/mailman/listinfo/openheart-l> > All messages transmitted by the OpenHeart-L are subject to the policies and > disclaimers posted at:> http://www.hsforum.com/listdisclaim> -----------------------------------------