Timing for surgery in patients with infective endocarditis and cerebrovascular complications--waiting may be best but results of early surgery are acceptable and improvements in neurology are common.

摘要

The timing of surgery for patients with infective endocarditis (IE) remains contentious, but over the last decade the number of patients operated on during the active phase has increased significantly [1,2]. Cerebral complications associated with IE appear to be similar in both aortic or mitral infections. These cerebrovascular complications may be due to either embolic stroke affecting between 8 and 15% of patients, or cerebral haemorrhage affecting 2-3%. Of the total number embolic events associated with endocarditis 65% affect the central nervous system, the incidence of which has been reported as between 9 and 40% [3, 4]. This range may be due to the difference in preponderance of the causative organisms to embolize; Staphylococcus aureus and Streptococcus vihdans have both been reported to be associated with an increased risk of neurological events [3-5].