INDICATIONS FOR SURGERY IN INFECTIVE ENDOCARDITIS - THE PROBLEMS IN BRAZZAVILLE (CONGO) - A STUDY OF 39 CASES

Authors gathered 39 infective endocarditis over a 5 year period. The aim of this study was to give an account of their experience about indications for surgery and outcome of patients. The standard for infective endocarditis' diagnosis were : sustained fever, heart murmur positive blood cultures, presence of vegetations, valvular mutilations by transthoracic echocardiography. No surgical treatment was required in 12 cases i.e. 30.8%. All patients were alive after a follow-up of 19 +/- 14 months (extremes : 1-48). A surgical treatment was required in 19 (48.7%) active infective endocarditis. Indications for surgery were heart failure in all cases, and embolism in 3 cases. Surgery has been performed in 3 cases : one died after 12 months because of left ventricular dysfunction. Among the 16 patients were surgery couldn't be performed, 15 died, and one was lost for follow-up. A surgical treatment was required in 8 (20.5%) active infective endocarditis because of heart failure in all cases, and of arterial emboli in 3 cases. Surgery has been performed in three of these 8 patients. No post-operative death occurred. On the other hand, among the five others patients, four died and only one was alive. On the whole lethality was 51.3%. When surgery was not required, no death occurred. When surgery was performed, lethality was 16.7%. When surgery was required but not performed, lethality was 90.5%. Infective endocarditis is an expensive disease. Authors stressed on prevention according to guidelines for taking systematic prophylactic measures.