Infectious endocarditis in valvular prostheses
Zghaib Abad, A.; Zanoniani Turá, C.; Sánchez Torres, G.
Archivos del Instituto de Cardiologia de Mexico 51(3): 249-258
1981
ISSN/ISBN: 0020-3785 PMID: 7283536 Document Number: 180361
The clinical picture and laboratory abnormalities, the sensitivity of the usual methods of diagnosis, the results of diverse therapeutic schemes and the mortality in 37 cases of prosthetic infective endocarditis at the Instituto Nacional de Cardiologia de Mexico in the last 8 yr were reviewed. No significant differences in the frequency of affection of diverse type of prosthesis; biological or mechanical, in either the mitral or aortic positions were found. Various differences exist in the clinical picture of these cases with respect to those with endocarditis in their natural values. Peripheral embolism, splenomegaly, petechiae and splinter hemorrages were frequently found. Septic shock, disseminated intravascular coagulation, signs of meningitis, ictericia and changing heart murmurs are almost exclusive of this type of endocarditis. The echocardiogram was not found to be a reliable means of diagnosis and hemocultures were reported to be negative in a high proportion of cases. Factors responsible for both eventualities were analyzed. Given the high frequency of infections by gram-negative organisms, it was concluded that the cephalosporins are the most recommended drugs of choice in prophylactic treatment. The main causes of death were intractable infection and severe heart failure; due to the high mortality rate of this series, a wide spectrum antibiotic is necessary as part of the therapy, particularly in cases with negative hemocultures. The indications for surgical treatment were analyzed: prosthetic dysfunction, uncontrollable heart failure or infection and repeated peripheral embolism.