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Hemodynamic Complications in Infective Endocarditis

  • Bernard Iung
Chapter

Abstract

Heart failure complications in infective endocarditis (IE) are mainly due to acute valvular regurgitation secondary to valve destruction. The pathophysiology of acute AR accounts for particularities in clinical and echocardiographic presentation which may represent diagnostic pitfalls. Acute regurgitations are poorly tolerated due to the lack of left ventricular adaptation. Heart failure occurs in approximately a third of patients with IE and is strongly associated with an increase in early and late mortality. Despite the lack of randomized trials, a large body of evidence shows that early surgery improves the prognosis of patients with heart failure, as attested by guidelines. However, decision-making is difficult during acute IE and it is likely that certain patients with IE and heart failure are denied surgery without appropriate risk-benefit analysis. Heart failure after the acute phase of IE also has a negative prognostic impact and highlights the need for careful follow-up.

Keywords

Endocarditis Heart failure Cardiogenic shock Acute regurgitations Echocardiography Prognosis Valvular surgery Risk-stratification 

Abbreviations

AR

Aortic regurgitation

BNP

B-type natriuretic peptide

ICE

International collaboration on infective endocarditis

IE

Infective endocarditis

NYHA

New York Heart Association

MR

Mitral regurgitation

Supplementary material

324212_1_En_9_MOESM1_ESM.avi (66.4 mb)
Video 9.1 Endocarditis on a native mitral valve. Transesophageal echocardiography: perforation of the anterior leaflet with two adjacent vegetations (left panel) and severe mitral regurgitation (right panel). See also Fig. 9.1a, b (AVI 68004 kb)
324212_1_En_9_MOESM2_ESM.avi (63.1 mb)
Video 9.2 Mycotic endocarditis (candida) on an aortic bioprosthesis. Transthoracic echocardiography, parasternal short-axis view: severe periprosthetic aortic regurgitation originating from a large periprosthetic abscess (AVI 64604 kb)
324212_1_En_9_MOESM3_ESM.avi (69.7 mb)
Video 9.3 Mycotic endocarditis (candida) on an aortic bioprosthesis. Transesophageal echocardiography: severe periprosthetic aortic regurgitation along the anterior leaflet of the mitral valve. See also Fig. 9.2a–c (AVI 61204 kb)
324212_1_En_9_MOESM4_ESM.avi (59.8 mb)
Video 9.4 Mitral endocarditis with eccentric regurgitant jet swirling in left atrium secondary to paracommissural prolapse of the anterior leaflet (A3). Transthoracic echocardiography, 2-chamber apical view (AVI 71404 kb)
324212_1_En_9_MOESM5_ESM.avi (66.4 mb)
Video 9.5 Mitral endocarditis with eccentric regurgitant jet swirling in left atrium secondary to paracommissural prolapse of the anterior leaflet (A3). Transesophageal echocardiography. See also Fig. 9.3a, b (AVI 68004 kb)
324212_1_En_9_MOESM6_ESM.avi (159.4 mb)
Video 9.6 Endocarditis on a bicuspid aortic valve. Transesophageal echocardiography: prolapse of the anterior aortic cusp and vegetations on both aortic cusps (AVI 163256 kb)
324212_1_En_9_MOESM7_ESM.avi (60.2 mb)
Video 9.7 Endocarditis on a bicuspid aortic valve. Transesophageal echocardiography: severe aortic regurgitation. See also Fig. 9.4a–d (AVI 61607 kb)

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Cardiology, Hôpital BichatDHU Fire and Paris Diderot UniversityParisFrance

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