Gonococcal endocarditis: report of a case and review of the literature.

Gonococcal endocarditis may appear in the extremes of cardiogenic and septic shock. These patients must be quickly stabilized and evaluated by echocardiography and cardiac catheterization where possible. Urgent surgical intervention for valve replacement may be necessary before complete stabilization of the patient's cardiac hemodynamics status is accomplished. Although the aortic valve is most commonly involved with gonococcal endocarditis, the mitral valve is involved as well and may present as a true emergency situation. Right-sided valve infections may be treated by a more conservative medical means if the patient does not deteriorate into a hemodynamic instability. Deterioration of the patient requires immediate intervention with catheterization and surgery in the absence of positive blood cultures to confirm the diagnosis of gonococcal endocarditis. Once the need for emergency surgical valve replacement has been determined the rules of complete debridement of all infected tissues, insertion of sutures into healthy annular tissue, and selection of an appropriate mechanical valve apply. Long-term antibiotic therapy is included in post-operative management.