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.
This combination of damaged valves, bacterial growth, and lack of a strong immune response results in infective endocarditis.Damage to the valves and endocardium can be caused by:
Altered, turbulent blood flow. The areas that fibrose, clot, or roughen as a result of this altered flow are known as jet lesions. Altered blood flow is more likely in high pressure areas, so ventricular septal defects or patent ductus arteriosus can create more susceptibility than atrial septal defects. Catheters, electrodes, and other intracardiac prosthetic devices. Solid particles from repeated intravenous injections. Chronic inflammation. Examples include auto-immune mechanisms and degenerative valvular lesions.The risk factors for infective endocarditis provide a more extensive list of conditions that can damage the heart. Diagnosis
In general, the Duke criteria should be fulfilled in order to establish the diagnosis of endocarditis. Although the Duke criteria are widely used, they have significant limitations. For example, the sensitivity of the Duke criteria for detecting infective endocarditis decreases when prosthetic heart valves are present.As the Duke criteria rely heavily on the results of echocardiography, research has addressed when to order an echocardiogram by using signs and symptoms to predict occult endocarditis among people who inject drugs and among non drug-abusing patients. However, this research is over twenty years old and it is possible that changes in the epidemiology of endocarditis and bacteria such as staphylococci make the following estimates incorrect. The blood tests C reactive protein (CRP) and procalcitonin have not been found to be particularly useful in helping make or rule out the diagnosis.