title: Right-sided infective endocarditis: surgical management.
abstract: Right-sided infective endocarditis (RSIE) accounts for 5-10% of all cases of infective endocarditis and is predominantly encountered among injecting drug users (IDUs). RSIE diagnosis requires a high index of suspicion as respiratory symptoms predominate. Prognosis of isolated RSIE is favourable, and most cases (70-80%) resolve following antibiotic administration. Surgical intervention is indicated in patients with persistent infection that does not respond to antibiotic therapy, recurrent pulmonary emboli, intractable heart failure and if the size of a vegetation increases or persists at >1 cm. Techniques can be divided into 'prosthetic' (valve replacement or prosthetic annular implantation) or 'non-prosthetic' ones (Kay's or De Vega's annuloplasty, bicuspidalization or valvectomy). In IDUs who run a high risk of complications, vegetectomy and valve repair, avoiding artificial material should be considered as the first line of surgical management as is associated with better late survival.
authors.affiliation: Section of Immunology and Infection, Faculty of Natural Sciences, Imperial College London, South Kensington, UK. k.akinosoglou07@imperial.ac.uk
authors.forename: Karolina
authors.initials: K
authors.lastname: Akinosoglou
authors.forename: Efstratios
authors.initials: E
authors.lastname: Apostolakis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Koutsogiannis
authors.forename: Vassilios
authors.initials: V
authors.lastname: Leivaditis
authors.forename: Charalambos A
authors.initials: CA
authors.lastname: Gogos
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality; D015150:Echocardiography, Doppler; D004502:Education, Medical, Continuing; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery; D018570:Risk Assessment; D012720:Severity of Illness Index; D015819:Substance Abuse, Intravenous / Q000150:complications; D015996:Survival Rate; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult