الفهرس 
PATHOLOGYOnly 14 pages are availabe for public view
 |  | from | 88 |  |  |
| | | from | 88 | | |
Abstract
Infective endocarditis is a very complex disease with a serious Prognosis. Prosthetic valve endocarditis (PVE) is aMicrobial infection of parts of a prosthetic valve or reconstructed native heart valve.
PVE should be classified as either being acquired perioperatively, and thus nosocomial (early PVE), or as community acquired (late PVE).
The diagnosis of infective endocarditis requires the integration of clinical, laboratory, and echocardiographic data. Although medical treatment can cure the majority of patients with infective endocarditis, a significant number among them will require sugical intervention.
The indications for surgery were congestive heart failure (60%), uncontrolled infection, large vegetations (≥10 mm) in recurrent embolism aortic root abscess or other forms of periannular extension of infection (25%), prosthetic valve dysfunction.
The goals of surgical therapy are as follows: 1) to eradicate the infection; 2) to repair cardiac destruction related to the infection; 3) to prevent the development of complications and relapse of infection.
Surgical treatment of PVE remains a significant challenge. Several factors contributed to these improved outcomes including (1) widespread use of TEE in making an early, accurate diagnosis. (2) An appreciation that like surgical infections elsewhere, surgery for PVE requires radical debridement of infected and devitalized tissue. (3) Improvements in myocardial protection, including routine use of retrograde cardioplegia, permitted longer and safer cardiac operations. (4) Cryopreserved homografts became more widely available.
When surgery is indicated for prosthetic mitral valve endocarditis, either mechanical or stented tissue valves may be considered for valve replacement
Currently, most surgeons consider homograft root replacement the procedure of choice for treatment of aortic PVE.
Cardiac transplantation may be considered in extreme cases with recurrent prosthetic valve endocarditis.