Document 0595
 DOCN  M9460595
 TI    [Surgery of endocarditis in the drug dependent and HIV patient. A
       prospective comparison with conservative treatment]
 DT    9404
 AU    Carrel T; Schaffner A; Pasic M; Ritter M; Oechslin E; Laske A;
       Niederhauser U; Schonbeck M; von Segesser LK; Turina M; Klinik fur Herz-
       und Gefasschirurgie, Universitatsspital; Zurich.
 SO    Helv Chir Acta. 1993 Dec;60(3):439-45. Unique Identifier : AIDSLINE
       MED/94164814
 AB    The incidence of infective endocarditis in drug addicts is increasing
       with the spreading of intravenous drug abuse. The tricuspid valve is the
       most commonly involved valve followed by the mitral valve. We evaluated
       prospectively 22 patients with a mean age of 23 years, presenting with
       addiction-associated endocarditis endocarditis and referred to our
       institution during a three-year period. The tricuspid valve was involved
       in 13 instances, mitral valve in 4, mitral plus tricuspid valve in 5
       patients and aortic valve in 1 case. Staphylococcus aureus was the most
       frequent infective organism (15x), followed by Streptococci (4x),
       Corynebacteria (2x) and one case with a mixed infection. Six patients
       were positive for an HIV-infection and 17 had evidence for a chronic
       viral hepatitis. Ten patients (3 of them HIV-seropositive) were treated
       surgically. Resection of the tricuspid valve with (1x) or without
       replacement (4x), resection of vegetations and valve repair (2x), mitral
       valve replacement (2x), aortic valve replacement (1x) were performed. In
       case of tricuspid endocarditis, the decision whether to proceed with
       resection, repair or replacement with a bioprosthesis was taken
       according to valve pathology and the psycho-social situation of the
       patient. When the vegetations involved only one leaflet and could be
       removed easily, vegetectomy with annuloplasty or with repair using
       autologous pericardium was performed. Valvulectomy without replacement
       was the chosen method for those where persistent or recurrent drug abuse
       could not be excluded. A bioprosthesis was inserted when the tricuspid
       valve was completely destroyed and there was a proven abstinence from
       drugs over a period of several weeks preoperatively.(ABSTRACT TRUNCATED
       AT 250 WORDS)
 DE    Adult  Aortic Valve/SURGERY  AIDS-Related Opportunistic
       Infections/MORTALITY/*SURGERY  Comparative Study  Corynebacterium
       Infections/MORTALITY/SURGERY  Endocarditis, Bacterial/MORTALITY/*SURGERY
       English Abstract  Female  Heart Valve Prosthesis  Human  Male  Mitral
       Valve/SURGERY  Postoperative Complications/*MORTALITY  Risk Factors
       Staphylococcal Infections/MORTALITY/SURGERY  Streptococcal
       Infections/MORTALITY/SURGERY  Substance Abuse,
       Intravenous/MORTALITY/*SURGERY  Survival Rate  Tricuspid Valve/SURGERY
       JOURNAL ARTICLE

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