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Background: Aortic valve surgery for infective endocarditis is still a high-risk procedure and the optimal valve substitute remains controversial. The aim of this study was to evaluate the results of our experience using homografts in the treatment of native (NVE) or prosthetic valve endocarditis (PVE)., Methods: Between May 1992 and December 2000, 37 patients with NVE and 16 patients with PVE underwent aortic valve replacement with homografts for infective endocarditis. In the two groups of patients the mean age was 57 and 61 years and 38% and 50% were in NYHA functional class IV or V. At the time of surgery, 28 patients had gross vegetations, 23 single or multiple abscess cavities, 3 ventricular septal perforations, and 9 mitral valve endocarditis. Homograft insertion was performed in a subcoronary position in 47 cases and as a root replacement in 6 cases. In 21 cases associated surgical procedures were also performed., Results: Follow-up was 94% complete at a mean of 56 months after valve replacement. There were 1 hospital and 7 delayed deaths; the actuarial survival at 5 years was 85.5 +/- 6% for NVE and 80.8 +/- 10% for PVE. Endocarditis recurred early in 2 cases (both with fungal infection) and late in 3 cases with an endocarditis-free 5-year period of 87.1 +/- 5%. Delayed echocardiography demonstrated aortic incompetence classified as grade II in 40 cases and as grade III and IV in 2 cases. Thirty-nine patients are in NYHA class I and 3 in class II or III., Conclusions: On the basis of our experience we can conclude that in case of acute endocarditis, if the results of surgery are to be optimized, an early diagnosis and aggressive medical therapy need to be combined with earlier surgical referral. In the presence of NVE without annular abscesses the likelihood of recurrent endocarditis is probably more likely to depend on the infective organism than on the type of valve implanted. Our results support the suggestion that in the presence of NVE with extensive annular abscesses or in case of PVE the homograft valve is the replacement device of choice.

We report a case of transmural myocardial infarction due to coronary embolism complicating infective endocarditis in a 41 year old woman. The infarction, clinically silent, was followed by rupture of left ventricular free wall, leading to hemopericardium and cardiac tamponade. The case is an uncommon complication of infective endocarditis, at the same time an uncommon cause of myocardial infarction.

Introduction: Short and long-term results of valve repair for pure mitral insufficiency resulting from native valve endocarditis are reported in 28 consecutive patients with a mean age of 55 years (range 18-74)., Methods: Six patients had acute endocarditis, with positive blood cultures in three of them. The mean time between onset of endocarditis symptoms and operation was 23 days in patients with acute endocarditis and 4.6 years in patients with healed endocarditis. Preoperatively, 87% of the patients were in NYHA class III. Indications for operation were heart failure (24 patients) and uncontrolled sepsis (4 patients). Mitral valvuloplasty was combined with other procedures in 4 patients. There was previous underlying valve pathology in 75%., Results: Mitral repair was performed according to the techniques proposed by Carpentier; in 2 cases we used an original technique consisting of a double-orifice repair. Only one patient died in the hospital (operative mortality: 3.5%). By actuarial methods 96% of the patients were alive 6 years postoperatively. During the follow-up period there was no recurrence of endocarditis and no reoperation for valvular insufficiency. Ninety-three per cent of the patients were in NYHA class I or II., Conclusions: We conclude that mitral valve repair for insufficiency resulting from bacterial endocarditis is possible in acute and healed disease, has a low operative mortality and has resulted in patients free of recurrent infection. Mitral valve repair is an attractive alternate to valve replacement in bacterial endocarditis.

Between January 1980 and May 1990 17 patients underwent surgery for prosthetic valve endocarditis at Cardiosurgical Department of Bologna University. Ten patients were female and seven male, the average age was 33 years (range 19 to 67 years). The interval from valve replacement to onset of symptoms of prosthetic valve endocarditis was less than 2 months in 5 patients and longer than 2 months in 12 patients. Sixteen of 17 infected prostheses were mechanical and one biological. All patients were surgically treated and the infected prostheses replaced with new valve prostheses. The hospital mortality rate for early prosthetic valve endocarditis was 60%, for late endocarditis was 16.5%, global hospital mortality was 29.4%.

The problem of infectious endocarditis (IE) is approached through a review of personal experience. The series examined consists of patients, 17 with active and 21 dormant infection. Furthermore 12 in the first group, 18 in the second had natural heart valves, while 5 in group I, 3 in group II had been given artificial ones. After an analysis of the aetiopathogenic, clinical and diagnostic aspects of the condition with emphasis on the fact that Staphylococcus aureus is currently more responsible for infections in natural valves and the epidermidis for acute prosthesis infections which have a higher early and late mortality rate (40% in hospital, 33.3% long-term), the paper discusses the criteria for surgical intervention. In line with opinions expressed in the literature, it is pointed out that, while the patient's haemodynamic status is certainly the main criterion for any decision, other factors such as embolism, impaired conduction, kidney failure and expansion of the infection to contiguous tissues, should not be under-estimated.

Since 1975 to 1979 24 patients affected by acute infective endocarditis were operated of valvular replacement. All patients presented increasing cardiac failure unresponsive to medical treatment; 48% of the cases had positive blood culture. In 5 patients the infective endocarditis occurred on previously implanted prosthetic valve. Surgical findings consisted in rupture of chordae tendineae, vegetation ad perforation of valvular cusps. Prosthetic valvular replacement was performed in all cases using mechanical valve (22) or porcine heterograft 85). Surgical mortality was 8,3%, while late mortality occurred on 12.5% of cases. The diagnostic considerations, concerning this disease, the surgical results and long term management are discussed.