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Infective endocarditis (IM) of the artificial cardiac valve (ACV) constitutes one of severe postoperative complications and presents a total spectrum and number of observations, concerning infectioning of the implanted ACV or of the adjacent tissues, which have had occurred in various time postoperatively. Wide introduction in practical cardiosurgery have caused the raising of the IM of ACV occurrence rate from 16 to 45%. Basing on analysis of data of 276 patients there were studied up the factors and conditions, predisposing to occurrence of IM in ACV. The main causes of a primary affection of natural cardiac valves in the patients were rheumatism and IM, the leading role in occurrence of bacteriemia have played nosocomial factors while performing stomatological, urological, gynecological and general surgical manipulations.

Infectious endocarditis can be caused by various microorganisms. Diagnostics of local infection by microbiological methods is not always effective. For that reason we performed a study aimed for direct detection of potential infectious agents by polymerase chain reaction in patients' heart valve tissue. DNA of infectious agents was revealed in 72% of heart valve tissue samples from patients with septic endocarditis; in studied samples, along with bacterial DNA, herpesviruses' DNA was detected. Obtained results confirm the presence of infection, which allows to perform specific diagnostics of infectious complications after implantation of prosthetic cardiac valves.

Progressive growth of infectious endocarditis morbidity has been noted in the world during recent 10 years. Among secondary forms of endocarditis rate of congenital heart defects is 21%. According to data of M.K. Rybakova (2007) the highest risk of development of infectious endocarditis (74%) is noted on bicuspid aortic valve. We present a clinical case of the patient C. with bicuspid aortic valve, secondary infectious endocarditis of aortic and mitral valves complicated with multiple abscessing of valvular apparatus of the heart. The following operation was carried out: mitral valve replacement with mechanical prosthesis ON-X 27 - 29 with preservation of subvalvular structures of posterior mitral valve leaflet, and replacement of aortic valve with mechanical prostheses ON-X-23. Despite development of severe complications in the patient C the outcome of disease was favorable. After course of rehabilitation the patient returned to work.

Self-obtained data about study of enterococci as etiologic agents of infectious complications after cardiovascular and transplantation surgery are presented in the article. 465 strains of enterococci were isolated from different biosubstrates. Isolation rate of different species of enterococci in blood, urine, fromwounds, trachea, cardiacvalves, as well as in the environment and on wear of healthcare workers were determined. Most frequently enterococci were isolated from urine (47.7% of cases) and from trachea (24.3% of cases). Enterococcal bacteremia was determined in 9.7% of cases and represented a significant part in Grampositive microflora--38.5% of all isolates. High resistance of enterococci to antibiotics and well lysis by phages were noted.

Samples from cardiac valves of 31 patients were analyzed by gas chromatography and mass spectrometry. The algorithm of mass spectrometric parameters was developed, which permitted the determination of about 200 known microbial fatty acids, aldehydes and sterols, sufficient for the detection and quantitative determination of more that 170 taxons of clinically significant microorganisms on the genus or species levels. The quantitative and qualitative differences in the composition of microbial markers of endocardial valves in normal and pathological states, particularly in cases of infectious endocarditis, were detected. The participation of 37 microbial taxons in the process was confirmed. The level of endocardium colonization in infectious endocarditis reached from 2 to 7 x 10(9) microbial cells/g of valvular tissue (which exceeded twofold the equivalent concentrations of the marker in the normal state). In terms of quantity, the leading role was played by Cardiobacterium hominis.

The authors have analyzed 139 patients with specific features of the clinical course of infectious pathology, massive and unusual destruction of the intracardiac structures, non-standard kinds of valvuloplasty. They required individualized strategy of diagnosing and operative treatment.

The study of the incidence and etiological pattern of infectious complications included 376 patients operated for acquired valvular disease. 40,280 bacteriological tests of the materials from the patients obtained during the operations and during the postoperative period as well as 30,113 sanitary bacteriological tests of the specimens from the cardiological operation unit were conducted. The possible use of the results of bacteriological monitoring for prediction of septic complications and optimization of antibiotic prophylaxis and therapy as well as for development and operation of a system of sanitary and hygienic measures for infection prevention was shown and statistically confirmed.