4.Extravalvular extension
Annular abscesses are more common with aortic (25-50%) than
mitral (1-5%) infections; in either case, surgical intervention is
preferred (survival: 25% medical, 60-80% surgical). Conduction
disturbances are a typical manifestation.
5.Peripheral embolisation
This is common (30-40%), but the incidence falls dramatically
following initiation of antibiotic therapy. Medical therapy is
appropriate for asymptomatic aortic or small vegetations. Surgical
therapy is indicated for recurrent or multiple embolisation, large
mobile mitral vegetations or vegetations that increase in size
despite appropriate medical therapy.
6.Cerebral embolisation
Operation within 24 hours of an infarct carries a 50% exacerbation
and 67% mortality rate, but the risk falls after two weeks (exacer-
bation <10%, mortality <20%). Following a bland infarct, it is
ideal to wait 2–3 weeks unless haemodynamic compromise
obligates early surgical intervention. Following a haemorrhagic
infarct, operation should be postponed as long as possible (4–6
weeks).
FFuurrtthheerr rreeaaddiinngg
Moon MR, Stinson EB, Miller DC. Surgical treatment of endocarditis.
Prog Cardiovasc Dis1997; 4400 : 239–64.