tratamento cirúrgico da endocardite infecciosa na fase aguda: experiência de três anos surgical treatment of infective endocarditis in the acute phase: a three-year experience

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ID: 185568
1987
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Abstract
O tratamento cirúrgico da endocardite na fase aguda vem-se impondo como o mais efetivo, em muitas circunstâncias clínicas. As contínuas modificações nos aspectos clínicos, diagnósticos e bacteriológicos desta afecção tornam necessária permanente avaliação dos resultados, nas situações concretas de atuação dos diversos grupos clínico-cirúrgicos. A definição de normas de conduta ante esta grave afecção tem-nos preocupado, ultimamente, por sua crescente participação em nossa prática clínica-cirúrgica. De novembro de 1983 a novembro de 1986, 6,7% das substituições valvares por nosso grupo cirúrgico deveram-se a endocardite (32 de 4,77 pacientes). A sede do processo infeccioso teve a seguinte distribuição: mitral 6 casos, aórtica 12 casos (um óbito), mitral e aórtica 6 casos (dois óbitos) prótese aórtica 4 casos (três óbitos), prótese mitral 2 casos (um óbito) mitral, aórtica e tricúspide 1 caso (um óbito) e parede do ventrículo esquerdo 1 caso. A idade variou entre 10 e 56 anos. Sete pacientes eram do sexo feminino e 24 do masculino. Todos os pacientes eram brancos. A análise dos achados anátomo-patológicos permitiu determinação de três grupos: no Grupo A, tivemos 11 operações por lesões valvares simples, consistentes basicamente de vegetações infectadas. Todos os pacientes sobreviveram e obtiveram alta hospitalar. Nos 15 pacientes do Grupo B, havia acometimento multivalvar, ou lesões complicadas por mutilações valvares extensas e/ou comunicações entre câmaras cardíacas; 5 pacientes faleceram. No Grupo C, houve 5 operações por infecções em próteses, ocorrendo 4 óbitos. O prognóstico favorável dos pacientes operados com lesões simples e o alto risco daqueles em que havia destruição tissular mais extensa e daqueles em que a endocardite se instalou em próteses, nos levam a defender o tratamento cirúrgico precoce das infecções valvares, em todos os casos em que não haja rápida resposta ao tratamento antibiótico.
Surgical treatment is becoming accepted as the best means of dealing with acute bacterial endocarditis in many clinical settings. The continuing changes in diagnosis, bacteriology and clinical picture of this disease must be accounted for by the surgical teams. Definition of the rules for management of this severe condition has been a matter of concern for us in the last years. From November 1983 to November 1986, 6.7% of the valvar substitutions in our Service were due to active infection (32 of 477 patients). The site of infection was the mitral valve in six patients, aortic valve in 12 patients (one death) mitral and aortic valves in six patients (two deaths), mitral prostheses in two patients (one death) aortic prostheses (three deaths), mitral, aortic and tricuspid valves in one patient (one death) and the wall of the left ventricle in one patient. Age varied from 10 to 56 years (m=29.2 years). Seven patients were females and 24 males. All patients were white. Analysis of the pathologic findings allowed us to define three subgroups: In subgroup A, 11 operations were done for simple valvar lesions. All patients left the hospital. Fifteen patients were in the subgroup of extensive valvar or perivalvar lesions, five of which died. Among the six prosthetic infections there were four deaths. The favorable outcome of the patients operated on for simple valvar lesions and the high risk of those who presented extensive tissue destruction or prosthetic infection makes us to prefer immediate surgical treatment if there is no clear response to antibiotics within 24 to 48 hours.
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Authors Iseu Affonso da Costa, Djalma Luiz Faraco, Fábio Sallum, Aldo Pesarini, Elson C Oliveira, Francisco Diniz Affonso da Costa, Álvaro B Soeiro
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Journal 2017 international conference on information technology systems and innovation, icitsi 2017 - proceedings
Year 1987
DOI
DOI not found
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-76381987000200005
Keywords
endocarditis

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