Prosthetic Valve Infective Endocarditis: Clinical Findings and Hospital Management of Twenty-Nine Patients

Abstract

Twenty-nine consecutive patients with prosthetic valve endocarditis were studied during five-year period. Patients were divided into early (<60 days) and late (>60 days) cases. Mean age was 27 years, 23 male and 6 females. Majority of the valve (24) was metallic with equal proportions of mitral and aortic prosthesis. Fever was present in more than 95% of cases, while breathlessness was more common in early cases. Cardiac murmurs were absent in 3040% of cases. Clinical splenomegaly was noted more commonly in late presenters while aortic root abscess and pericardial effusion were more common in early cases (P. NS). Majority of the patients, especially early cases, had already received antibiotic therapy. Overall culture positivity was 55%; it was 40% in early cases. Streptococcus viridans was the main isolate in late presenters. Transthoracic echocardiography provided valuable diagnostic clues in 70% cases. Intractable heart failure, uncontrolled infection, aortic root abscess and recurrent emboli were main complications. However emergency cardiac surgery carried a high mortality (66%). Overall mortality was 52%.