Heart failure associated with infective endocarditis. A review of 40 cases.

Abstract

Thirty one (78%) of 40 consecutive patients (aged 13-79, mean 44 years) with infective endocarditis had congestive heart failure at presentation. Twenty six (65%) had had rheumatic heart disease and 17 (43%) patients had prosthetic valves. Eight (20%) patients had undergone dental procedures within three months of presentation. Blood cultures were positive in only 22 (55%) of the patients. In nine (41%) of them streptococci of the viridans group were isolated and in seven (32%) patients endocarditis was due to Staphylococcus aureus. Eight patients had Q fever endocarditis. Sixteen patients required operation because of haemodynamic deterioration while they were in hospital; 11 patients had native valves and five had prosthetic valves. Seven had emergency operations and were pyrexial at that time. Four of the seven died in hospital. Of the 12 who were alive and well after surgery only two required further surgery two and three years after the initial operation. Twelve (30%) of the 40 patients died in hospital; in 10 death was mainly due to left ventricular failure or congestive heart failure. All patients died who had renal failure (four cases), myocardial infarction (two cases), complete heart block (one case), or ventricular fibrillation (two cases) before operation. Six (33%) of the 18 patients with culture negative endocarditis died. Two of the four patients seen and treated more than 12 weeks after the onset of symptoms died, as did three of the five patients with prosthetic valves who required surgery while in hospital. Three patients with neurological complications survived and only two (29%) of the seven patients with blood cultures that were positive for Staphylococcus aureus died. Of these 40 high risk patients optimal antibiotic treatment and early surgery for haemodynamic difficulty ensured that 28 (70%) were discharged from hospital alive and well.

Invasion and Killing of Human Endothelial Cells by Viridans Group Streptococci

“…These bacteria frequently enter the bloodstream following trauma to oral tissues (12,17,41,58) and can then adhere to surfaces of abnormal or previously damaged heart valves (15,21,29,47) or become implanted in arterial atherosclerotic plaques (11). Streptococci growing on heart valve surfaces (causing infective endocarditis) become encased in a matrix of fibrin and platelets, which form macroscopic verrucous lesions and can lead to valve perforation, abnormalities in cardiac conduction, valve ring abscesses, pericarditis, aneurysm of the sinus of Valsalva, and release of peripheral emboli (21,56). Viridans group streptococci are the most common cause of native valve endocarditis in humans, accounting for 45 to 80% of cases (5,55).…”

Association of pyogenic spondylitis with congestive heart failure in Korea: a nationwide longitudinal cohort study

“…We do not know whether PS occurs as a complication of IE or vice versa, but we do know based upon past studies that IE is an uncommon infection of the cardiac valves, where CHF is the most important complication [23]. Varma et al [24] reported that 31 (78%) of 40 consecutive patients (aged 13-79, mean 44 years) with IE had CHF at presentation. Mills et al [25] also reported that out of 144 patients with IE, 79 (55%) developed CHF.…”

The surgical treatment of infective endocarditis

“…The propensity of Staphylococcus aureus endocarditis to produce invasive infection with rapid destruction of valvular tissue, annular and myocardial abscesses with subsequent heart block, peripheral septic emboli, and systemic shock have prompted many centers to adopt a more aggressive attitude toward staphylococcal endocarditis, with early surgery and valve replacement [2,5,6,8,10]. The most difficult decision is, however, the appropriate timing of operation before complications such as renal failure, pulmonary edema, or cardiogenic shock occur.…”

“…Since aortic valve replacement was first described in the treatment of acute Klebsiella endocarditis by Wallace et al in 1965 [1], surgery has played an increasingly important role in the overall management of infective endocarditis [2][3][4][5][6][7][8][9][10][11]. Published series reporting the results of valve replacement in infective endocarditis are, however, often difficult to interpret and compare because of the imprecise definition of infective endocarditis, and of failure to differentiate between active infection and healed valvular lesions [4,6]. We have, therefore, reviewed our surgical experience of infective endocarditis from the Open Heart Surgical Unit at St. Vincent's Hospital in Melbourne.…”