Infective Endocarditis in King Faisal Specialist Hospital: A Review of 35 Consecutive Adult Patients

Abstract

Thirty-five adult patients with an established diagnosis of infective endocarditis were treated at the King Faisal Specialist Hospital between 1976 and 1985. There were 26 males and 9 females with a mean age of 32 years. Endocarditis was found on a native valve in 14 patients, on a prosthetic valve in 14, on a congenital lesion in 6, and 1 patient had dilated cardiomyopathy. Positive blood cultures were obtained in 25 patients (71%). The commonest infective organism of native valves was Streptococcus viridans and of prosthetic valves was Staphylococcus epidermidis. Brucella accounted for 3 cases. Echocardiogram was available in 27 patients and vegetation could be demonstrated in 14 (52%). Pericardial effusion was seen in 6 patients and was associated with a high complication rate. Twelve patients needed early surgery with 3 deaths (25%) resulting. The indications for early surgery in the active stage were hemodynamic deterioration in 7, persistent infection in 4 and fear of embolism in one. Five patients had elective surgery with no mortality. All Brucella endocarditis patients needed early surgery. In the whole group there were seven early deaths, and two late deaths in a mean follow-up period of 35 months.

A rare case of aortic sinuses of valsalva fistula to multiple cardiac chambers secondary to periannular aortic abscess formation from underlying Brucella endocarditis

“…All aforementioned complications are associated with high mortality and serious prognosis. However, experts recommend open surgery of complicated Brucella endocarditis (BE) within some days from diagnosis, but there is no consensus about the optimal time of surgery in BE [ 6 ], [ 7 ]. The present guidelines for the surgery of Brucella infective endocarditis are not straightforward as in non- Brucella endocarditis cardiac surgery has been recommended within a week from diagnosis [ 7 ].…”

“…However, experts recommend open surgery of complicated Brucella endocarditis (BE) within some days from diagnosis, but there is no consensus about the optimal time of surgery in BE [ 6 ], [ 7 ]. The present guidelines for the surgery of Brucella infective endocarditis are not straightforward as in non- Brucella endocarditis cardiac surgery has been recommended within a week from diagnosis [ 7 ]. The absence of sufficient evidence to define the optimal time of surgical intervention in BE is complicated by aortic annular abscess related to lack of available data about surgery of BE in the advanced stage.…”

A Review of Brucella endocarditis

“…Though the cardiovascular involvement is <2% causing endocarditis, it accounts for the main cause of mortality. 1 In a series of 1,500 cases of human brucellosis, there were only five cases (0.3%) of endocarditis, 7,8 yet another recent study reported 4% of endocarditis. 9 The disease is rare in western countries where the agent is B. abortus, which causes mild disease.…”

Brucella endocarditis in prosthetic valves

“…However, 80% of the fatal cases are caused by endocarditis (2). In endemic areas, Brucella endocarditis has been reported in 8.5% to 14.6% of all patients treated for endocarditis (3)(4)(5). A case of Brucella endocarditis on two valvular prostheses successfully treated in Charité -Campus Benjamin Franklin (Berlin, Germany) by a combined medical and surgical approach is described.…”