Bartonella henselae bacilli in cardiac valve of a patient with blood culture-negative endocarditis. The bacilli appear as black granulations.
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Endocarditis, infective

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves. more...

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Endocarditis can be classified by etiology as either infective or non-infective, depending on whether a foreign micro-organism is causing the problem.

Infective endocarditis

As the valves of the heart do not actually receive any blood supply of their own, which may be surprising given their location, defense mechanisms (such as white blood cells) cannot enter. So if an organism (such as bacteria) establish hold on the valves, the body cannot get rid of them.

Normally, blood flows pretty smoothly through these valves. If they have been damaged (for instance in rheumatic fever) bacteria have a chance to take hold.

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Determinants Of Early And Long-Term Survival In 61 Patients Undergoing Surgery For Active Infective Endocarditis - Abstract
From CHEST, 10/1/00 by Okike N. Okike

Okike N Okike, MD(*); Jia Jin Zheng, MD; Thomas J Vander Salm, MD; Robert A Lancey, MD; James S Gammie, MD; A Thomas Pezzella, MD; Jorge M Balaguer, MD and Yunsheng Ma, MD. UMass Medical Center, Worcester, MA.

PURPOSE: Active endocarditis is a potentially fatal disease and surgical intervention remains a challenge. We investigated the determinants of adverse outcome in patients undergoing surgery for active IE (infective endocarditis).

METHODS: From 1988 to 1999, 61 patients who fulfilled Dukes criteria for IE underwent surgical interventions. Mean age was 53.7(14-81). Fourteen patients had prosthetic valve endocarditis. Follow up was obtained in all the surviving patients. Logistic regression analysis was used to explore factors associated with operative death. Cox-hazard regression analysis was done for independent determinants of long-term survival. The variables tested included age, embolism, presence of fever, double valve infection, vegetation, Staphylococcal infection, degree of surgical urgency, and valvular destruction.

RESULTS: Operative mortality was 23%(14/61). Multivariate logistical regression analysis indicates that Staphylococcal infection (OR=4.24, 5% Cl 1.03, 17.37) and valvular destruction (OR=8.03, 95% Cl 1.47, 43.9) were significantly predictive of operative death. Forty-seven patients who survived the operation were followed for a mean of 3.9 years (2months - 11 years). The 5-year survival rate was 75.6%. We did not find any single factor that had a significant impact on long-term survival.

CONCLUSION: Active IE is associated with a high operative mortality. Early operation for Staphylococcal IE may reduce the degree of valvular destruction and possibly improve operative mortality. The long-term outcome of surgical survivors is encouraging.

COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group

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