Active Infective Aortic Valve Endocarditis with Infection Extension (eBook)

FOREWORD 6
CONTENTS 7
MAIN ABBREVIATIONS USED IN TEXT 10
ABSTRACT 11
INTRODUCTION 14
Clinical presentation: acute or chronic 14
Native and prosthetic aortic valve endocarditis 14
Infective double valve disease (mitral valve disease secondary to aortic valve endocarditis) 15
Paravalvular abscess 15
Microorganisms 15
Diagnostic criteria and Duke criteria 15
Epidemiology of active infective endocarditis 16
Infective endocarditis of prosthetic valves 16
Septic shock as a part of vasoactive (vasodilatory) shock 17
Types of infection extension 17
Value of echocardiography in diagnosis and follow-up of patients suffering from AIE 18
Convergence methods 19
Estimation of vena contracta 19
Surgery and indications for surgery 20
Surgical indications 20
AIMS OF INVESTIGATION 21
PATIENTS AND METHODS 21
ECHOCARDIOGRAPHIC STUDY 25
Echocardiographic measurement 25
Definitions of abscess 25
Abscess classification according to stage of development 26
Stages I-III 26
Abscess classification according to extension 27
Localized abscess 28
Circular abscess 28
Aortoventricular dehiscence 28
Vegetations 28
Primary aortic valve active infective endocarditis with secondary mitral valve disease requiring concomitant mitral surgery 28
Local metastasis 28
Jet lesion 31
SURGERY AND INDICATIONS FOR SURGERY 34
RESULTS 36
Clinical data 36
Clinical features in patients suffering from AIE with aortic root abscess 36
Abscess localization 38
Vegetations 39
Aortic valve regurgitation 39
Microorganisms responsible for endocarditis in patients suffering from AIE with root abscess 39
Medical treatment of studied patients before surgery 40
Value of preoperative echocardiography 41
Clinical outcome after surgery in patients suffering from root abscess In- hospital mortality and relation to echocardiographic staging 42
Patients suffering from AIE complicated by vasoactive shock 43
Patients suffering from root abscess without mitral valve involvement: LV function after surgery 45
Mitral valve disease secondary to aortic valve endocarditis 45
Preoperative vs. postoperative LV function assessed by echocardiography in patients treated by double valve surgery compared with the group with isolated aortic valve surgery 46
LV function in patients divided according to preoperative abscess classification assessed by echocardiography 47
Function of implants in patients with aortic valve surgery: homograft vs Shelhigh 48
Multivariate statistical analysis of patients suffering from ring abscess according to preoperative and postoperative risk predictors 49
DISCUSSION 50
Preconditioning risk factors for endocarditis 50
Bacteriology 51
Value of echocardiography 51
Vegetations and emboli 52
Infection extension below aortic valve 52
Surgical results Localized vs. large forms of abscess 52
Stages of abscess (early and late forms) 53
Prosthetic endocarditis 53
Study of patients suffering from endocarditic double valve disease treated by double valve surgery 53
Shrinkage of LV after valve operation 54
Timing of surgery 54
Complications (mitral valve, fistula and VSD) 55
Hemodynamic characteristics assessed perioperatively 55
Comparison of two groups of AIE patients with aortic root abscess treated by single aortic valve replacement with homograft or stentless valve 55
Function of implants (Table 23) 56
Multivariate analysis 56
Summary 57
CONCLUSIONS 58
REFERENCES 59