Surgical management of infective endocarditis complicated by ischemic stroke

Abstract

Embolism to the central nervous system is a frequent and important complication of infective endocarditis. While early surgery improves outcomes in many groups of patients with infective endocarditis, ischemic stroke secondary to septic embolism carries the risk of hemorrhagic transformation and neurological deterioration with heparinization and cardiopulmonary bypass. We review the literature regarding the surgical management of infective endocarditis in patients with cerebral emboli.

Vascular Complications of Infective Endocarditis: Diagnosis and Management

“…Embolism of a vegetation fragment or a rupture of an intracranial mycotic aneurysm are the two ways in which stroke complicates IE [ 5 ] and can be asymptomatic. The clinical consequences are related to the size of the emboli [ 8 ]. Neurological imaging can be helpful to detect patients with asymptomatic neurological complications and to identify patients in whom neurological complications may influence further therapeutic decisions.…”

Personality Disorder as the Initial Presentation of a Complicated Endocarditis: Diagnostic Challenges in the CARDIO-PSYCHIATRY

“…The treatment of the disease requires the management by a team of cardiothoracic surgery; whether or not a B.P.D, there was an urgent need to retire the vegetations because of the history of two silent like strokes in the history of the patient [7]. It's of great importance to report the postsurgery evolution of our patient, since the actual knowledge of the postsurgery prognosis and evolution are yet to be understood totally.…”

The management of infective endocarditis complicated by stroke

“…Whilst historically it was felt that delaying surgery up to 4 weeks in patients who have had an ischaemic stroke was required, more recent studies state that early surgery is beneficial for outcome. This is especially in the context of patients with acute heart failure, uncontrolled infection or recurrent embolism risk . In patients with ICH or reduced conscious levels, it is generally accepted in clinical practice to delay surgery by up to 3‐4 weeks or until neurological recovery is made .…”

“…This is especially in the context of patients with acute heart failure, uncontrolled infection or recurrent embolism risk. 32 In patients with ICH or reduced conscious levels, it is generally accepted in clinical practice to delay surgery by up to 3-4 weeks or until neurological recovery is made. 33,34 In the case of ICMA's, endovascular therapy and coiling of the aneurysm is preferred and is less invasive and this can be performed when detected if at risk of rupture.…”