Surgical approach to the management of Brucella endocarditis.
OBJECTIVE
Brucella endocarditis is a rare complication of Brucella infection; however, it is the major cause of deaths in those infected with this disease. In this study, we aim to discuss the results of seven cases who underwent surgery for Brucella endocarditis in our clinic using the knowledge gathered through the literature.


METHODS
We reviewed seven patients with Brucella endocarditis, who underwent surgery in our department between October 1990 and April 2007. Brucella endocarditis was diagnosed by physical examination, laboratory findings, serological tests, blood culture, transthoracic and trans-oesophageal echocardiography. All cases underwent surgery after 4-6 weeks of medical therapy. Antimicrobial treatment was maintained for an average of 6 months after surgery. The mean follow-up was 27.4 months.


RESULTS
The mean age was 30 years (range, 5-47 years). Four of the patients were male. Of the cases, aortic valve replacement (AVR) was performed in three, mitral valve replacement (MVR) was performed in three and combined aortic and mitral valve replacement (AVR+MVR) was performed in one patient. Pericardial tube drainage was done in one patient because of pericardial effusion and cardiac tamponade that developed 13 days after surgery. One (14.3%) of our patients died 15 days after surgery. The others were discharged.


CONCLUSIONS
We concluded that medical and surgical treatment had to be performed simultaneously for the successful management of Brucella endocarditis, a fatal complication of Brucella infection.
Tasdemir
Kutay
K
Department of Cardiovascular Surgery, Erciyes University School of Medicine, 38039 Kayseri, Turkey.
Kaya
Mehmet Gungor
MG
Mavili
Ertugrul
E
Gunebakmaz
Ozgur
O
Ozbek
Ali
A
Sarli
Bahadir
B
Yarlioglues
Mikail
M
Emirogullari
Naci
N
D000293:Adolescent; D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D002006:Brucellosis / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult