Abstract 13386: Pulmonary Complications in Right Sided Endocarditis
Right-sided endocarditis (RSE) is a life-threatening infectious disease with increasing incidence; there is scant data, however, regarding pulmonary complications.
Methods: we assessed patients referred for TEE with suspected RSE. Transthoracic (TTE) and transesophageal (TEE) echocardiography were performed, and thorax computed tomography (CT) undertaken within 2 weeks of TEE. Follow-up was 1 year, and endpoints cardiac surgery and death.
Results: 92 patients had evidence RSE. Most patients were female (58%), aged 45 ±18 years old. All patients except 7 (8%) had positive blood cultures, mainly staphylococcus (43 %), followed by gram - (15%) and fungal species (10%), with most infections catheter related (84%). Vegetations were large (21±13 mm) and cardiac thrombosis frequent (Table 1). Thorax CT was undertaken in 46 patients (50%), with contrast in 28 (60%). Pulmonary findings were septic emboli in 28 patients (60%), mainly with associated cavitation (11 patients). Staphylococcus was the most common infectious agent (14 patients) followed by fungus. Multiple abscesses were common, and size ranged from 4 to 88 mm. No pattern of lung predominance was seen in the abscess distribution. Pleural effusion was common (32 patients, 68%), mainly bilateral. A pulmonary infarct was observed in 21 patients (45%). Except for one thoracotomy for empyema, pulmonary complications were medically treated. In patients who underwent CT, there were 6 deaths and 5 cardiac surgery. Cardiac surgery was related to the presence of tricuspid vegetation, but the only radiological feature associated with a higher mortality was the presence of an abscess (p < 0.05).
Conclusion: Thrombosis is frequent in patients with RSE, with a high incidence of pulmonary complications. Lung abscesses are the usual radiological presentation, followed by pulmonary infarction. Independently of cavitation, a higher mortality is found for pulmonary abscess. Thorax CT can add prognostic information in RSE.
- © 2013 by American Heart Association, Inc.