[Arterial embolism of the limbs in infectious endocarditis of the heart valves].
Nine cases of infective endocarditis (IE) on native valves, complicated by arterial embolism of the limbs (AEL), were collected between June 1974 and October 1988 (prevalence 4.3 percent). Among the 11 AEL recorded, 9 involved the lower limbs and 2 the upper limbs. The diagnosis, suspected in patients with acute ischaemia (n = 6), transient (n = 1) or pseudophlebitic (n = 1) pain, or discovered by systematic pulse examination (n = 3), was confirmed by Doppler ultrasound (n = 3), angiography (n = 2) or oscillometry (n = 4). AEL occurred 2.8 weeks on average after the onset of treatment; it appeared 6 months after the end of treatment in 1 case and preceded the diagnosis of IE by 1 to 6 weeks in 3 cases. The causative organisms isolated in 7 cases were: non-haemolytic streptococci (n = 4), Staphylococcus aureus (n = 1), Haemophilus parainfluenzae (n = 1) and enterococcus (n = 1). Vegetations were found in 6 of the 7 patients explored by echocardiography. Two cases of embolism of the femoral artery required embolectomy. Effective heparin anticoagulation was obtained in only one patient. Six patients underwent valve replacement in the acute phase of endocarditis. After a mean follow-up period of 32 months (range 3 to 120 months), only one patient has symptoms (claudication of the left upper limb); 5 patients are asymptomatic with a reduced (n = 5) or abolished (n = 2) pulse. Three embolisms have left no sequelae. Altogether, AEL are not uncommon in infective endocarditis. They rarely influence the functional prognosis and are detected by systematic palpation of the pulses. Anticoagulation in effective doses is discussed. Attempts at removing the obstruction should be made only in cases with poorly tolerated proximal embolism. In patients with multiple or recurrent embolic accidents, valve replacement may be considered.
de Gennes
C
C
Service de Médecine interne, groupe hospitalier Pitié-Salpêtrière, Paris.
Souilhem
J
J
Lê Thi Huong
D u
Du
Chapelon
C
C
Raguin
G
G
Wechsler
B
B
Blétry
O
O
Godeau
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries; D004617:Embolism / Q000209:etiology*; D004696:Endocarditis / Q000150:complications / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D004698:Endocarditis, Subacute Bacterial / Q000150:complications; D005121:Extremities / Q000098:blood supply*; D005260:Female; D006351:Heart Valves / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors
Embolie artérielle des membres au cours des endocardites infectieuses sur valves natives.