Question Title: Endocarditis x3 and surgical risk comparisons

Forum: The Heart Forum
Topic: Heart Disease

My question(s) pertain to my father. He is currently in the hospital with endocarditis (3rd time this has happened) and he has several complications with it this time - burst brain abscess, septicemia, meningitis. The doctors tell my mother that the endocarditis is the main culprit. He was hospitalized for this each time and was given IV antibiotics and a home care regimen as well when discharged the first 2 times. I believe he may have had scarlet or rheumatic fever as a child - but I am not certain of this.

Now that he is regaining his strength, they have mentioned to her that two valves of the heart are infected this time, and that surgery would be a good idea for him. My mother is wondering if surgery at this time is a good idea considering his neurological state. The abscess was in the left frontal lobe and there are currently marked effects from it bursting. However, it could also be temporary effects since he also had meningitis. Keeping that in mind, what are the risks for patients with 3x history of endocarditis that DO NOT have valve repair/replacement surgery as compared to patients who DO have the surgery? (For that matter, ANY patients with endocarditis who have had the surgery recommended - no matter how many times they have had the endocarditis)

I would really appreciate some information on this. I can't find this kind of comparison anywhere.

Dear Julia, thank you for your question. This is a difficult situation since I don't know your father's entire medical history. However, I think I can add a few points. First, it sounds like he needs to have the two infected valves replaced to cure the infection (endocarditis) or else he will probably continue to have further complications. Without removing the source of the infection, antibiotics will never be curative at this point. Second, the risks of surgery are hard to assess, but there would be a higher than normal risk of a cerebral hemorrhage given the meningitis and brain abscess. Only his cardiologist and the cardiothoracic surgeon can accurately assess that and other risks for you. However, what are the alternatives? Without valve replacement surgery, he probably won't get better and may continue to worsen. Third, the risks of surgery relating to the number of prior episodes of endocarditis are complicated. It depends upon how his heart function was affected by the prior endocarditis episodes and what degree of damage the present infection has caused. I think you should have a long discussion with his physicians at this point and relate the concerns that you voiced in this posting. Certainly, your family faces a difficult decision, so good luck and best wishes.

I hope you have found this information useful. Information provided in the heart forum is for general purposes only. Specific diagnoses and therapies can only be provided by your physicians. Please feel free to write back with additional questions. If you would like to make an appointment at the Cleveland Clinic Foundation, please call 1-800-CCF-CARE. Good luck!

[The Heart Forum]      [The Heart Forum Archives]