title: Management of infective endocarditis with cerebral complications.
abstract: OBJECTIVE
  Management of patients with infective endocarditis complicated by neurological deficits is challenging. No clear management guidelines have been defined, and the timing of surgery remains controversial. The purpose of this study was to evaluate our management algorithm.
  
  
  METHODS
  Thirty-eight adult patients with left-sided infective endocarditis undergoing valve surgery were analyzed. Before the operation, enhanced brain computed tomography (CT) was performed to rule out a cerebral complication. Pre and postoperative data were retrospectively reviewed to clarify whether our algorithm was effective. Sixteen patients having neurological complication (CVC group) were compared with 22 patients without neurological complication.
  
  
  RESULTS
  Age, sex, New York Heart Association (NYHA) functional class, affected valve and pathogens were not different between two groups. Mean interval from the onset of neurological dysfunction to cardiac operation was 27.8 ± 27.8 days (median 23 days). Of the 16 CVC group patients, 12 experienced cerebral infarction. Mass effects were seen in 3 patients, with 1 of these 3 patients died following aneurysm rupture. Mycotic aneurysm was detected in 4 patients, with 3 undergoing successful staged operations. Mortality and postoperative neurological exacerbation in CVC group was 6.3% (1 patient). Most patients who fulfilled the algorithm showed good outcomes.
  
  
  CONCLUSIONS
  Our suggested management algorithm for infective endocarditis appears effective.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hirosaki University Graduate School of Medicine.
authors.forename: Wakako
authors.initials: W
authors.lastname: Fukuda
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Daitoku
authors.forename: Masahito
authors.initials: M
authors.lastname: Minakawa
authors.forename: Kozo
authors.initials: K
authors.lastname: Fukui
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Ikuo
authors.initials: I
authors.lastname: Fukuda
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000785:Aneurysm, Infected / Q000382:microbiology / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002533:Cerebral Angiography / Q000379:methods; D002544:Cerebral Infarction / Q000382:microbiology / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000382:microbiology* / Q000401:mortality; D019091:Critical Pathways; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome