Endocarditis - New realities

• Autor(a) principal: Robalo, Miguel
• Data de Publicação: 1998
• Outros Autores: Teixeira, Helena, Godinho, António, Sousa, Anabela, Marcão, Isabel
• Tipo de documento: Artigo
• Idioma: por
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://revista.spmi.pt/index.php/rpmi/article/view/2102
• topic: endocardite; Duke Endocarditis Service; ecocardiografia; endocarditis; Duke endocarditis service; echocardiography

Despfte a stable incidence of endocarditis (END) in recent years,the epidemiological features have chan­ged. An increased incidence of right-sided heart dise­ase has emerged, associated with an increasing inci­denceof intravenous drug use. Objective:A retrospective study in patients (Pts) wfth endocardftis, diagnosed using the Duke Endocarditis Service (DES) criteria, was carried out. Clinical and echocardiographic parameters were evaluated. Population and methods: During the period of May 92 December 1995, 32 Pts (25 male and 7female, with a mean age of  32.5years), had definite diagnostic crite­ ria of END by DES. The clinical course and echocar­ diographic exams were evaluated. Epidemiologic aspects, presentation, aetiological agents, disease evolu­ tionduring hospitaladmission,complications and echocardiographic aspects were analyzed. Results: All patients,exceptone were admitted with fever; 28 patients (27,5%) demonstrated no structural cardiac problem, 2 had congenital cardiac defects and 2 rheumatic valvular disease; 22 patients (68%) were intravenous (LV.) drug users. Staphylococcusaureus was the responsible aetiologlcalagent in 16 cases. Eight patients experienced septic embolic complica­tions (4 pulmonary, 2 splenic 1 digitaland 1cerebral), all patients were LV. drug users. The endocarditis was localized to the tricttspid valve in 20 patients (63%), aortic valve in 8, mitral valve in 6 and the pulmonary valve in 1 patient. The majority had involvement of one cardiac valve only, 3 cases involved multiple valves. Vegetations were singular in 21 patients (66%) and multiple in 7 patients. There were 5 cases of major valvular regurgitation: 3 aortic, 1 mitrat 1 tricuspid and 1 aortic abscess with a shuntfrom the left ventricle to the right atrium Five patients (16%) required surgical correction, with good post-operative outcomes. There was one operative mortality. TTE was diagnostic in31 patients (97%) and TTE was necessary in 4 patientsfor further evaluation namely persistent fever or hemodynamic compromise. Conclusions: 1)- This study revealed a predominan­ce of right-sided endocarditis in young LV. drug users without pre-existent tricuspid valvular disease, with a 25% incidence of septic embolization. St. aureus was tlie predominant bacterium cultured 2)-The inmal 1TE was diagnostic in all but one case. TTE was importantfor furtherevaluation in paüents with haemodynamic compromise oruncontrolled in­ fection.