title: [Surgical management of infective endocarditis with cerebrovascular complications].
abstract: OBJECTIVE
  To investigate the result of surgical treatment of active infective endocarditis in patients with recent cerebrovascular events, and to evaluate the optimal indication and timing of surgical intervention.
  
  
  METHODS
  The clinical data of 26 patients with cerebrovascular complications before surgery Between December 2007 and December 2013 were analyzed retrospectively. There were 17 male and 9 female patients, aged (42±14) years. Types of disease included single aortic valvular disease (n=8), single mitral valvular disease (n=12), multiple valvular disease (n=5), and aortic valvular disease with ventricular septal defect (n=1). Type of cerebrovascular complication included cerebral infarction (n=25) and cerebral hemorrhage (n=1). Thirty-one valves were involved in 26 patients, mechanical prosthetic valve replacement (n=25), bioprosthetic valve replacement (n=4), and mitral valve repair (n=2).
  
  
  RESULTS
  The interval between onset of cerebrovascular event and surgical intervention was less than 14 days (n=3), 14 to 21 days (n=13), over 21 days (n=10), and the mean was (20±4) days. There were 33 vegetations found intraoperatively. The mean size of vegetations was (10±4) mm and 19 were found in mitral valve. Two patients died in hospital. One case relapsed after 1 year and underwent reoperation for prosthetic valve endocarditis. The remaining patients recovered with cardiac function of New York Heart Association class I to II after the period of 3 months to 5 years follow-up.
  
  
  CONCLUSIONS
  Appropriate surgery may effectively improve the outcome of IE patients with cerebrovascular complications. The surgical indications and risks of further neurologic deterioration after cardiac surgery should be assessed comprehensively before surgical intervention.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Changtian
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Biao
authors.initials: B
authors.lastname: Xu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Haiwei
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Zhongdong
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Jing
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, China; Email: dr.demin@126.com.
authors.forename: Demin
authors.initials: D
authors.lastname: Li
mesh_terms: D000328:Adult; D001021:Aortic Valve; D000082882:Bicuspid Aortic Valve Disease; D002543:Cerebral Hemorrhage / Q000209:etiology*; D004696:Endocarditis; D004697:Endocarditis, Bacterial / Q000150:complications / Q000601:surgery*; D005260:Female; D006330:Heart Defects, Congenital; D006345:Heart Septal Defects, Ventricular; D006349:Heart Valve Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors