Clinical study
Late prosthetic valve endocarditis: Clinical features influencing therapy

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Abstract

To assess the clinical features which might influence therapy, we studied 43 patients with late prosthetic valve endocarditis (LPVE). Twenty patients (47 per cent) survived. Of patients with streptococcal LPVE 61 per cent (11 of 18) survived compared to 36 per cent (nine of 25) of the patients with nonstreptococcal LPVE (p < 0.10). Among patients with new regurgitant murmurs 33 per cent (nine of 27) survived versus 69 per cent (11 of 16) without such murmurs (p < 0.03). Of patients with moderate to severe congestive heart failure (CHF) 16 per cent (three of 19) survived compared to 71 per cent (17 of 24) with mild or no CHF (p < 0.001). The concurrence of two of these three features, i.e., nonstreptococcal etiology, a new regurgitant murmur or moderate to severe CHF, was assciated with a mortality rate of 50 to 90 per cent. Persistent fever during therapy, a regurgitant murmur, atrioventricular conduction disturbances and relapse frequently reflected myocardial invasion. In view of the poor outcome with medical therapy and late reoperation, early surgical intervention should be considered when two of the three features noted are present or when myocardial invasion is suspected.

References (21)

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Cited by (112)

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    Surgical therapy as an adjunct to medical (antimicrobial) therapy has been described since these early studies of PVIE. In 1978, Karchmer et al proposed that surgical intervention for late PVIE should be considered for patients who had clinical features associated with a poor response to medical treatment, specifically those who had nonstreptococcal etiology, new regurgitant murmur, or significant heart failure.21 Numerous subsequent studies have described the outcome of PVIE for these therapeutic strategies (Table V).

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This study was supported in part by the Algisa Censale Memorial Fund.

1

From the Department of Medicine and Surgery, Harvard Medical School and the Department of Medicine (Infectious Disease Unit) and Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Present address: University of Alabama School of Medicine, Birmingham, Alabama 35294.

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