Aortic Insufficiency in Bacterial Endocarditis

The records of 28 patients with bacterial endocarditis and aortic valve insufficiency were studied to determine clinical indications for valve replacement before bacteriologic cure can be accomplished. The four patients who never developed heart failure did well with medical therapy alone. Seven of 11 patients with mild heart failure died suddenly during treatment. At autopsy four of these were found to have had myocardial infarctions, presumably embolic. Seven of eight patients with moderate or severe heart failure who were treated medically died, whereas four of five with severe heart failure who had aortic valve replacement survived. Patients with bacterial endocarditis and aortic insufficiency who have severe heart failure should have aortic valve replacement performed immediately. Early valve replacement should also be considered in patients with only mild heart failure because they appear to be at significant risk of sudden death from embolic myocardial infarction or arrhythmia.