Rarity of invasiveness in right-sided infective endocarditis

The Journal of Thoracic and Cardiovascular Surgery

Nabin K. Shrestha¹  Steven M. Gordon²  Syed T. Hussain³  Penny L. Houghtaling⁴  James Witten⁵ 

[1] Department of Infectious Disease, Medicine Institute, Research Institute, Cleveland Clinic, Cleveland, Ohio;Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio;Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Research Institute, Cleveland Clinic, Cleveland, Ohio;Emergency Department, Hvidovre University Hospital, Copenhagen, Denmark;Lerner College of Medicine, Research Institute, Cleveland Clinic, Cleveland, Ohio

关键词: endocarditis;    right sided;    invasiveness;    chamber pressure;   

DOI  :  10.1016/j.jtcvs.2017.07.068

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveThe rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients.Patients and MethodsFrom January 2002 to January 2015, 1292 patients underwent surgery for active IE, 138 right-sided and 1224 left-sided. Among patients with right-sided IE, 131 had tricuspid and 7 pulmonary valve IE; 12% had prosthetic valve endocarditis. Endocarditis-related invasiveness was based on echocardiographic and operative findings.ResultsInvasive disease was rare on the right side, occurring in 1 patient (0.72%; 95% confidence interval 0.02%-4.0%); rather, it was limited to valve cusps/leaflets or was superficial. In contrast, IE was invasive in 408 of 633 patients with aortic valve (AV) IE (65%), 113 of 369 with mitral valve (MV) IE (31%), and 148 of 222 with AV and MV IE (67%). Staphylococcus aureus was a more predominant organism in right-sided than left-sided IE (right 40%, AV 19%, MV 29%), yet invasion was observed almost exclusively on the left side of the heart, which was more common and more severe with AV than MV IE and more common with prosthetic valve endocarditis than native valve IE.ConclusionsRarity of right-sided invasion even when caused by S aureus suggests that invasion and development of cavities/"abscesses" in patients with IE may be driven more by chamber pressure than organism, along with other reported host–microbial interactions. The lesser invasiveness of MV compared with AV IE suggests a similar mechanism: decompression of MV annulus invasion site(s) toward the left atrium.

【 授权许可】

Unknown