Replacement of the valve with a mechanical or bioprosthetic artificial heart valve is necessary in certain situations:
Patients with significant valve stenosis or regurgitation causing heart failure
Evidence of hemodynamic compromise in the form of elevated end-diastolic left ventricular or left atrial pressure or moderate to severe pulmonary hypertension
Presence of intracardiac complications like paravalvular abscess, conduction defects or destructive penetrating lesions
Recurrent septic emboli despite appropriate antibiotic treatment
Large vegetations (> 10 mm)
Persistently positive blood cultures despite appropriate antibiotic treatment
Prosthetic valve dehiscence
Relapsing infection in the presence of a prosthetic valve
Abscess formation
Early closure of mitral valve
Infection caused by fungi or resistant Gram-negative bacteria.The guidelines were recently updated by both the American College of Cardiology and the European Society of Cardiology. There was a recent meta-analysis published that showed surgical intervention at seven days or less is associated with lower mortality. Prognosis
Infective endocarditis is associated with 18% in-hospital mortality. As many as 50% of people with infective endocarditis may experience embolic complications. Epidemiology
In developed countries, the annual incidence of infective endocarditis is 3 to 9 cases per 100,000 persons. Infective endocarditis occurs more often in men than in women. There is an increased incidence of infective endocarditis in persons 65 years of age and older, which is probably because people in this age group have a larger number of risk factors for infective endocarditis. In recent years, over one-third of infective endocarditis cases in the United States was healthcare-associated. Another trend observed in developed countries is that chronic rheumatic heart disease accounts for less than 10% of cases.
Biguanides have also been found to act synergistically when used in combination with diamidines, with propamidine isethionate and hexamidine being the most commonly used. A limitation of diamidine use is relative corneal toxicity with long term use. A combined regimen of propamidine, miconazole nitrate, and neomycin has also been suggested. Due to the potential for negative longterm visual outcomes with AK, therapy is usually started with a combination of a biguanide and a diamidine. Early use of high dose dual therapy helps to eliminate both trophozoite and cyst forms of the organism, while also preventing deep penetration of cysts into the corneal stroma. Cysts that are not eradicated from the cornea will cause recurrence. The treatment is often initiated by instilling drops onto the surface of the eye every hour, 24 hours a day, for at least the first 48–72 hours. If an appropriate response to therapy, this may be reduced to hourly administrations during the day only, which is continued for several weeks to months.Beyond anti-amoebic therapies, there is also a role for topical steroids of anti-inflammatory medications in the treatment of Acanthamoeba keratitis. During infection, severe inflammation in the cornea and anterior chamber can cause more severe symptoms including pain and visual disturbance. Topical steroids may be used to reduce this inflammation and thereby alleviate symptoms. However, the role of steroids is typically very limited, because their dampening of the immune response may lead to worsening of the infection. Additionally, steroids can increase the number of trophozoites in the cornea by inducing excystation.