Endocardite infecciosa: estudo Doppler-ecocardiografico prospectivo

Assef, Jorge Eduardo; Pontes Júnior, Sérgio C; Gimenez, Vera Márcia L; Jorge, Sérgio do Carmo; Jacooud, Eduardo A; Piegas, Leopoldo S; Sousa, J. Eduardo M. R

Estudo de aspectos Doppler-ecocardiográficos em portadores de endocardite infecciosa (EI) e sua correlaçäo com prognóstico e evoluçäo. Cento e oito pacientes com suspeita de EI a fim de determinar se a presença de vegetaçäo (veg), tamanho, moblidade e local e acometimento identificam, por si só, grupos de alto risco. O diagnóstico se fez presente em 93,9% dos pacientes com EI do lado direito do coraçäo e em 77,3% daqueles com EI do lado esquerdo. Pacientes com (84,2%) e sem (15,8%) veg näo apresentaram diferença significativa na incidência de complicaçöes (embolias, ICC e óbito), o mesmo acontecendo em relaçäo ao tamanho. Pacientes com veg aórtica (Ao) apresentaram maior incidência de ICC (Ao 53,8 x Mitral (MI) 31,0% x Tricúspide (Tric0 3,7%), necessidade de cirurgia (Ao 69,2%) x Mi 34,5% x Tric 3,7%) e óbito (Ao 30,7% x Mi 13,7% x Tric 7,4%). Fenômenos embólicos foram observados em 81,4% dos pacientes com veg em Tric. Oito pacientes apresentaram EI em prótese Ao, com tratamento cirúrgico em 5 (62,5%) e óbito em 2 (25%) enquanto dentre os 12 com EI em prótese Mi, 7 (58,3%) necessitaram de cirurgia e 3 (25%) foram a óbito. Derrame pericárdico foi constatado em 51 pacientes (47,2%), ruptura de cordoalha em 14 (12,9%) e abcesso para-valvar em 6 (5,5%), os portadores deste encaminhados á cirurgia. A Doppler-ecocardiografia constitui-se método de excelência na confirmaçäo diagnóstica da EI e os aspectos por ela determinados relacionam-se, por vezes, com o prognóstico e a evoluçäo

Purpose:

To study of the Doppler-echocardiographic aspects in patients with IE and its correlation with the prognosis and evolution.

Patients and Methods:

One hundred and eight patients with clinical of IE were prospectively studied by Doppler-echocardiography (D-E) in order to determine whether the simple presence of vegetation, its size, mobility and place of attachment could identify high risk groups. Vegetations were classified according to its size (longest axis) into small (veg < 5 mm), medium (5 mm < veg < 10 mm) and large (veg < 10 mm); according to its kind into sessible or mobile and according to its appearance into cotton like or calcifzed.

Results:

Patients with (84.2%) and without (15.8%) vegetations didnt show any significant difference in the complications incidence (emboli, heart failure or death) and the same happened with its size. However, patients with aortic positioned vegetations showed ligher incidence of HF (Aortic 53.8 x Mitral 31.0% x Tricuspid 3.7%) need for surgery (Aortic 69.2% x Mitral 34.5% x Tricuspid 3.7%) and death (Aortic 30.7% x Mitral 13.7% x Tricuspid 7.4%). Emboli were observed in 81.4% of the patients with tricuspid valve vegetations. Eight patients showed IE on aortic prothesis. Five of them needed surgical treatment and 2 of them died. Among 12 patients with IE on mitral prothesis, 7 needed surgery and 3 died. Pericardial effusion were verified in 51 patients (47.2%), chordal rupture in 14 (12.8%) and valve abcess in 6 (5.5%). All patients with valve abcess were submitted to surgery.

Conclusion:

Doppler-echocardiography is an excellent method in the diagnosis of IE and its aspects may have, sometimes, a positive correlation with the prognosis and patients evolution.