Document Detail

Valvular perforation in left-sided native valve infective endocarditis.
MedLine Citation:
PMID:  20014188     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Left-sided native valve infective endocarditis (LNVIE) can result in mitral (MP) and aortic (AP) valve perforation, the prognostic significance of which remains poorly defined. HYPOTHESIS: Valvular perforation is associated with worse outcomes. METHODS: Retrospective review of patients with LNVIE during 1998-2005 was performed to examine characteristics and outcome predictors of LNVIE complicated by valve perforation. Patients were stratified as: group A: MP or AP detected by transesophageal echocardiography (TEE) or surgery; group B: no TEE evidence of MP or AP. RESULTS: A total of 123 patients were included (group A = 47, group B = 76). In group A, 35 patients (74.5%) had MP alone, 11 (23.4%) had AP alone, and 1 patient had both. Severe valvular insufficiency was encountered more in group A (85.1% versus 59.2%, p = 0.003), so was hemodialysis (40.4% versus 17.1%, p = 0.004) and indications for valvular surgery (93.6% versus 77.6%, p = 0.02). Group A had a higher rate of in-hospital death (31.9% versus 15.8%, p = 0.04). Among patients who had an indication for valvular surgery, the in-hospital mortality rate for those who underwent valvular surgery was 16.7% in group A, and 7.9% in group B (p = 0.4), compared to those who did not undergo surgery (71.4% versus 33.3%, p = 0.04). Amongst survivors, hospital stay was on average 9.2 d longer in group A (38.9 versus 29.7 d, p = 0.05). Univariate analysis revealed association between lower survival and valvular perforation (odds ratio [OR]: 0.4, 95% confidence interval [CI]: 0.17-0.95), that was lost after adjusting for hemodialysis. CONCLUSIONS: Valve perforation complicating LNVIE is associated with hemodialysis, severe valvular insufficiency, and significant morbidity and mortality. Compared to conservative management, early surgical intervention is associated with improved survival.
Khaled Bachour; Hammam Zmily; Mohammad Kizilbash; Khaled Awad; Rayan Hourani; Hazem Hammad; Jack D Sobel; Jalal K Ghali; Donald Levine; Luis Afonso
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  32     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-28     Completed Date:  2010-04-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E55-62     Citation Subset:  IM    
Copyright Information:
Copyright 2009 Wiley Periodicals, Inc.
Division of Cardiology, Wayne State University, Detroit, Michigan, USA.
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MeSH Terms
Aortic Valve / microbiology*,  surgery,  ultrasonography
Case-Control Studies
Echocardiography, Transesophageal
Endocarditis / complications*,  mortality
Heart Valve Diseases / microbiology*,  mortality*,  surgery,  ultrasonography
Hospital Mortality
Length of Stay
Middle Aged
Mitral Valve / microbiology*,  surgery,  ultrasonography
Renal Dialysis
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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