Management of Infective Endocarditis with Cerebral Complications
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- Fukuda Wakako
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine
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- Daitoku Kazuyuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine
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- Minakawa Masahito
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine
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- Fukui Kozo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine
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- Suzuki Yasuyuki
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine
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- Fukuda Ikuo
- Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine
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Purpose: Management of patients with infective endocarditis complicated by neurological deficits is challenging. No clear management guidelines have been defined, and the timing of surgery remains controversial. The purpose of this study was to evaluate our management algorithm.<br>Methods: Thirty-eight adult patients with left-sided infective endocarditis undergoing valve surgery were analyzed. Before the operation, enhanced brain computed tomography (CT) was performed to rule out a cerebral complication. Pre and postoperative data were retrospectively reviewed to clarify whether our algorithm was effective. Sixteen patients having neurological complication (CVC group) were compared with 22 patients without neurological complication.<br>Results: Age, sex, New York Heart Association (NYHA) functional class, affected valve and pathogens were not different between two groups. Mean interval from the onset of neurological dysfunction to cardiac operation was 27.8 ± 27.8 days (median 23 days). Of the 16 CVC group patients, 12 experienced cerebral infarction. Mass effects were seen in 3 patients, with 1 of these 3 patients died following aneurysm rupture. Mycotic aneurysm was detected in 4 patients, with 3 undergoing successful staged operations. Mortality and postoperative neurological exacerbation in CVC group was 6.3% (1 patient). Most patients who fulfilled the algorithm showed good outcomes.<br>Conclusions: Our suggested management algorithm for infective endocarditis appears effective.
収録刊行物
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- Annals of Thoracic and Cardiovascular Surgery
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Annals of Thoracic and Cardiovascular Surgery 20 (3), 229-236, 2014
Annals of Thoracic and Cardiovascular Surgery 編集委員会