Journal
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
Volume 42, Issue 3, Pages 470-479Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/ejcts/ezs084
Keywords
Right-sided infective endocarditis; Pacemaker endocarditis; Implantable cardioverter-defibrillator endocarditis; Tricuspid valve replacement; Tricuspid valvulectomy; Tricuspid valve repair
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Right-sided infective endocarditis (RSIE) accounts for 5-10% of all cases of infective endocarditis and is predominantly encountered among injecting drug users (IDUs). RSIE diagnosis requires a high index of suspicion as respiratory symptoms predominate. Prognosis of isolated RSIE is favourable, and most cases (70-80%) resolve following antibiotic administration. Surgical intervention is indicated in patients with persistent infection that does not respond to antibiotic therapy, recurrent pulmonary emboli, intractable heart failure and if the size of a vegetation increases or persists at > 1 cm. Techniques can be divided into 'prosthetic' (valve replacement or prosthetic annular implantation) or 'non-prosthetic' ones (Kay's or De Vega's annuloplasty, bicuspidalization or valvectomy). In IDUs who run a high risk of complications, vegetectomy and valve repair, avoiding artificial material should be considered as the first line of surgical management as is associated with better late survival.
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