6. Infectious Endocarditis (IE)

One of the heart diseases that may affect patients of any age is infectious endocarditis (IE).  In IE, heart valve(s) are destroyed by bacteria etc.  IE may develop in patients with no obvious heart diseases, but often develops in patients with some underlying heart disease.  For example, ventricular septal defect (VSD), mitral valve prolapse (the valve dislocates to the left atrium), mitral regurgitation, or bicuspid aortic valve (normally aortic valve has 3 cusps), and others may make underlying causes. IE develops often after tooth extraction, some injury or infection, drug user especially when the same needle is used for 2 people or more.

Q: Why is infectious endocarditis (IE) dangerous?

In patients with IE, depending on the responsible bacteria, antibiotics is not necessarily effective, and if the vegetation (fragile mass of bacterial body etc.) breaks and migrates to the brain, serious problems such as cerebral embolism (stroke) will develop.  Moreover, if the patient needs emergency surgery when the bacteria are still alive and active (i.e., active IE), sometimes surgeons have to put artificial materials such as sutures or artificial valves to the site which was infected.

Thus, during the surgery, we do thorough debridement (i.e., removal of infected tissue and bacteria), reconstruct the damaged valve, and when necessary apply artificial valve.

Taking advantage of experiences in valve repair surgery or LV restoration surgery, we succeeded in saving most patients with IE (VHD case 4).
Valve cusps or leaflets can be repaired. Using the LV restoration techniques, even when the base of the aortic or mitral valve is destroyed by the infection, it can be reconstructed so that the valve can be repaired or replaced thereafter (Figure).

Q: What if an artificial valve develops endocarditis ?

Prosthetic valve endocarditis (PVE), which is endocarditis of artificial valve(s), is one of the serious conditions among IE. We aggressively do surgery for patients with PVE. 
PVE is not easy to treat medically, but surgery is often demanding, which requires experienced and skillful hands.  Surgery for PVE needs more techniques and considerations than for usual valve surgery.

It is in part because surgeons often have to reconstruct not only the valve but also its base (e.g., mitral annulus or aortic ring), and in part because cares should be taken to bleeding tendency, infection, multiple organ protection etc. 

Figure shows an example of aortic ring reconstruction for PVE with aortic root abscess (see bibliography).

If you or your patient has PVE, please consult a specialist of cardiovascular surgery, at latest before major complications develop such as cerebral embolism of vegetation or mycotic aneurysm or its rupture.