Infective endocarditis: An atlas of disease progression for describing, staging, coding, and understanding the pathology

Pettersson, Gösta; Hussain, Syed T.; Shrestha, Nabin K.; Gordon, Steven M.; Fraser, Thomas G.; Ibrahim, Khalid S.; Blackstone, Eugene H.

doi:10.1016/j.jtcvs.2013.11.031

Cited by 45 publications

(41 citation statements)

References 12 publications

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“…11 Active IE was defined by surgical findings, histopathologic evidence of active infection, or positive cultures from operative specimens. 10,12 Cases not meeting criteria for active IE were excluded and coded as remote/healed IE (272 cases), leaving a study population of 1292 active IE cases. All active cases met Duke criteria for IE.…”

Section: Patients and Methods Patientsmentioning

confidence: 99%

Rarity of invasiveness in right-sided infective endocarditis

Hussain

Shrestha

Witten

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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Rarity of right-sided invasion even when caused by S aureus suggests that invasion and development of cavities/"abscesses" in patients with IE may be driven more by chamber pressure than organism, along with other reported host-microbial interactions. The lesser invasiveness of MV compared with AV IE suggests a similar mechanism: decompression of MV annulus invasion site(s) toward the left atrium.

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Section: Patients and Methods Patientsmentioning

confidence: 99%

Rarity of invasiveness in right-sided infective endocarditis

Hussain

Shrestha

Witten

et al. 2018

The Journal of Thoracic and Cardiovascular Surgery

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“…The key to understanding IE is appreciating the pathologic progression (16). Circulating organisms, bacteria or other, adhere to damaged areas of the endocardium, (valves, ventricular septal defects), endothelium (patent ductus), or foreign material exposed in the bloodstream (prosthetic heart valves, pacemaker leads).…”

Section: Pathophysiology and Microbiology Of Iementioning

confidence: 99%

“…When tissue integration involves the valve annulus, the infection invades the extravascular areas; "invasive disease". Causative microorganism/pathogen, position (aortic, mitral, or rightsided), and type of infected valve (native or prosthetic) are important for pathology and prognosis (10,11,16). Bacteria and fungi have a species-specific repertoire of virulence factors that allow them to establish and maintain IE.…”

Section: Pathophysiology and Microbiology Of Iementioning

confidence: 99%

Current AATS guidelines on surgical treatment of infective endocarditis

Pettersson¹,

Hussain²

2019

Ann. Cardiothorac. Surg.

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147

109

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The 2016 American Association for Thoracic Surgery (AATS) guidelines for surgical treatment of infective endocarditis (IE) are question based and address questions of specific relevance to cardiac surgeons. Clinical scenarios in IE are often complex, requiring prompt diagnosis, early institution of antibiotics, and decisionmaking related to complications, including risk of embolism and timing of surgery when indicated. The importance of an early, multispecialty team approach to patients with IE is emphasized. Management issues are divided into groups of questions related to indications for and timing of surgery, pre-surgical work-up, preoperative antibiotic treatment, surgical risk assessment, intraoperative management, surgical management, surveillance, and follow up. Standard indications for surgery are severe heart failure, severe valve dysfunction, prosthetic valve infection, invasion beyond the valve leaflets, recurrent systemic embolization, large mobile vegetations, or persistent sepsis despite adequate antibiotic therapy for more than 5-7 days. The guidelines emphasize that once an indication for surgery is established, the operation should be performed as soon as possible. Timing of surgery in patients with strokes and neurologic deficits require close collaboration with neurological services. In surgery infected and necrotic tissue and foreign material is radically debrided and removed. Valve repair is performed whenever possible, particularly for the mitral and tricuspid valves. When simple valve replacement is required, choice of valve-mechanical or tissue prosthesis-should be based on normal criteria for valve replacement. For patients with invasive disease and destruction, reconstruction should depend on the involved valve, severity of destruction, and available options for cardiac reconstruction.For the aortic valve, use of allograft is still favored.

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“…IDU was defined as injection of drugs within 3 months before admission. Invasive disease was defined as extension of the invasive process beyond cusps or leaflets into the annulus or surrounding structures [17]. Immunosuppression was defined as administration of recognized immunosuppressive agents (oral corticosteroids or other agents like those used in solid organ transplantation or rheumatologic disorders) for more than 30 days at the time of IE diagnosis [2].…”

Section: Definitionsmentioning

confidence: 99%