Infective endocarditis

Infective endocarditis is being observed with increased frequency in patients presenting with specific risk factors, such as intravenous drug abuse, human immunodeficiency virus, congenital heart defects, degenerative valve disease, heart surgery, pacemaker implantation, and therapeutic immunosuppression due to organ transplantation, in children, infective endocarditis has changed, with half of the cases occurring nowadays after surgery for congenital heart disease. Infective endocarditis complicates the natural history of hypertrophic cardiomyopathy in 5% to 9% of cases. Transesophageal echocardiography is highly accurate in the detection of complications, such as paravalvular abscesses or mycotic aneurysms, that are frequent in native aortic valve endocarditis. Embolus is the most common extracardiac complication associated with infective endocarditis; valvular vegetations seem to be a significant risk factor for embolism only in case of infection with Streptococcus viridans. Abdominal computed tomography is indicated for monitoring splenic involvement in septic infarcts and abscesses. Cerebrovascular accidents occur in nearly 10% infective endocarditis of the left-sided heart, and a similar incidence was found in patients receiving anticoagulants and in patients who did not. Early surgery in native left-sided endocarditis was accomplished with only 4% hospital mortality and 6% late mortality. Aggressive surgery is recommended even in very ill patients. Homograft aortic root replacement for active aortic prosthetic endocarditis showed a favorable outcome.