Infective endocarditis: a prospective study of 60 consecutive cases.

Sixty cases of infective endocarditis were studied prospectively between May, 1985 and December, 1988. There were 40 males and 20 females with a mean age of 28 years. Endocarditis was found on normal valves in 13 patients, on rheumatic valves in 30, on congenital lesions in 8, on prosthetic valves in 4 and on mitral valve prolapse in 5 cases. Positive blood cultures were detected in 35 patients (58%). In addition bone marrow culture was positive in 1 and valves removed on surgery grew causative organisms in eight. Thus the total culture positive cases were 44 (73%). The commonest infective organism was Streptococcus viridans. Uncommon organisms accounted for 10 cases (17%). Two dimensional echocardiography (2D-Echo) was done in all cases and vegetations were detected in 48 patients (80%). 2 D-Echo was helpful not only in the detection of vegetations but also in the demonstration of other complications of endocarditis like ring abscesses, ruptured chordae, ulceration of aortic root, interventricular septum abscess, and mitral xenograft obstruction. Early surgery was performed in 31 patients. In this group of patients severe heart failure was present in 21, embolization in 10, persistence of fever in 15 and large vegetations in 19. Of the 29 patients treated medically, 2 died. The mortality in the surgical group was seen in 5 (16%) with a mean follow-up of 15 months. The major reason for a large number of our patients undergoing surgery is the fact that this is a referral Center and patients were sent later or when there was a failure of medical treatment.