Surgical treatment is becoming accepted as the best means of dealing with acute bacterial endocarditis in many clinical settings. The continuing changes in diagnosis, bacteriology and clinical picture of this disease must be accounted for by the surgical teams. Definition of the rules for management of this severe condition has been a matter of concern for us in the last years. From November 1983 to November 1986, 6.7% of the valvar substitutions in our Service were due to active infection (32 of 477 patients). The site of infection was the mitral valve in six patients, aortic valve in 12 patients (one death) mitral and aortic valves in six patients (two deaths), mitral prostheses in two patients (one death) aortic prostheses (three deaths), mitral, aortic and tricuspid valves in one patient (one death) and the wall of the left ventricle in one patient. Age varied from 10 to 56 years (m=29.2 years). Seven patients were females and 24 males. All patients were white. Analysis of the pathologic findings allowed us to define three subgroups: In subgroup A, 11 operations were done for simple valvar lesions. All patients left the hospital. Fifteen patients were in the subgroup of extensive valvar or perivalvar lesions, five of which died. Among the six prosthetic infections there were four deaths. The favorable outcome of the patients operated on for simple valvar lesions and the high risk of those who presented extensive tissue destruction or prosthetic infection makes us to prefer immediate surgical treatment if there is no clear response to antibiotics within 24 to 48 hours.
endocarditis, infective