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Titolo:
CARDIAC AND EXTRACARDIAC ABSCESSES IN INF ECTIVE ENDOCARDITIS
Autore:
THOMAS D; DESRUENNES M; JAULT F; ISNARD R; GANDJBAKHCH I;
Indirizzi:
GRP HOSP PITIE SALPETRIERE,SERV CARDIOL,47-83 BLVD HOP F-75651 PARIS 13 FRANCE GRP HOSP PITIE SALPETRIERE,SERV CHIRURG THORAC & CARDIOVASC F-75651 PARIS 13 FRANCE
Titolo Testata:
Archives des maladies du coeur et des vaisseaux
fascicolo: 12, volume: 86, anno: 1993, supplemento:, S
pagine: 1825 - 1835
SICI:
0003-9683(1993)86:12<1825:CAEAII>2.0.ZU;2-R
Fonte:
ISI
Lingua:
FRE
Soggetto:
COMPLICATING BACTERIAL-ENDOCARDITIS; PROSTHETIC VALVE ENDOCARDITIS; AORTIC ROOT ABSCESS; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; SEPTIC EMBOLI; RING ABSCESS; REPLACEMENT; DIAGNOSIS; SURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
D. Thomas et al., "CARDIAC AND EXTRACARDIAC ABSCESSES IN INF ECTIVE ENDOCARDITIS", Archives des maladies du coeur et des vaisseaux, 86(12), 1993, pp. 1825-1835

Abstract

Cardiac abscesses are observed in 20 to 30 % of cases of infective endocarditis and in at least 60 % of prosthetic valve endocarditis. The aortic valve ring is more frequently affected than the mitral valve ring. A cavity contiguous with a cardiac chamber forming a pseudo-aneurism or a closed purulent collection, the abscess may extend to the neighbouring cardiac structures or to the ascending aorta. This extension may cause conduction defects, abnormal communications between the cardiac chambers, pericardial disease and, exceptionally, myocardial ischaemia, complications which are clinical signs of abscess formation in patients with infective endocarditis. The presence of a cardiac abscessis a poor prognostic factor in infective endocarditis. The diagnosis must be made at an early stage when surgical treatment is optimal. Themost valuable investigation is transoesophageal echocardiography witha sensitivity of over 80 % and a specificity of about 95 %. This investigation has become practically routine in all patients with endocarditis in order to diagnose abscesses at an early stage, especially in cases of aortic or prosthetic valve endocarditis. Information about thesite, size and extension of the abscess may be obtained and existing or potential complications may be envisaged with a view to surgery. Other imaging diagnostic techniques, such as angiography, CT scanning and nuclear magnetic resonance imaging have a number of disadvantages and are not more sensitive than transoesophageal echocardiography. Surgical techniques depend on the site and extension of the abscess. They are sutured or closed with dacron or pericardial patches after having been cleaned and filled with formolated resorcin glue. The valvular prosthesis is inserted either in anatomical position or in a sub or supracoronary dacron tube necessitated by the perivalvular extension of theinfectious lesions. These complex procedures may require associated coronary reimplantation or revascularisation when the coronary ostia are affected. The highest operative mortality is observed in prosthetic valve endocarditis with abscess and extra-annular prosthetic implants. The risk of secondary valvular dehiscence, often recurrent, is much higher when there is an abscess at operation. Extracardiac abscesses incases of infective endocarditis are mainly observed in the cerebral and/or splenic territories. They may become the main problem, especially cerebral abscesses, but they rarely require surgery.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 17:58:52