title: Bicuspid aortic valve--A silent danger: analysis of 50 cases of infective endocarditis.
abstract: We analyzed 50 cases of bicuspid aortic valve endocarditis in patients who presented to St. Thomas' Hospital from 1970 through 1998. These represented 12.3% of the 408 cases of native valve endocarditis (NVE). All patients were male, and their mean age was 39 years. Forty-five of the 50 cases were pathologically proven; 47 were clinically definite according to the Duke criteria and 49 according to our modifications of the Duke criteria. Viridans streptococci and staphylococci accounted for 72% of cases. The prevalences of clinical features were similar to those seen in NVE: fever (temperature >/=38 degrees C, 74%) and malaise (70%), although dyspnea was more frequent (36%). There was a high incidence of serious complications (72% heart failure; 30% periannular abscesses). Surgery was required during the initial admission in 82% of cases. Overall mortality was 14%, and surgical mortality was 9%. Few patients knew they had a "heart condition," and a bicuspid aortic valve was detected in only 35% of echocardiograms performed before surgery.
authors.affiliation: St. Thomas' Hospital, London, SE1 7EH, London, United Kingdom.
authors.forename: C C
authors.initials: CC
authors.lastname: Lamas
authors.forename: S J
authors.initials: SJ
authors.lastname: Eykyn
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000002:abnormalities* / Q000473:pathology; D015984:Causality; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D006349:Heart Valve Diseases / Q000151:congenital*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000453:epidemiology; D016019:Survival Analysis; D006113:United Kingdom / Q000453:epidemiology