From January/1983 to March/1988, 1512 patients were submitted to valve replacement in the Instituto do Coração, Of these, 28 (1.8%) presented endocarditis in a valvular prosthesis. Seventeen patients were males, their ages varying from 18 to 67 years, with an average and standard deviation of 36.7 ± 12.9. The evolution of the functional class (F. C.) revealed 11 patients in (F. C.) IV, 12 in F. C. III and 5 in F. C. II (NYHA). Eight (28.5%) patients were operated on under emergency conditions. One patient had a mechanical valve and 27 had biological valves. The blood cultures were positive in 14 (50%) patients, the agent most commonly found being Streptococcus viridans (5 cases). Preoperative echocardiogram in 27 patients showed good correlation with the surgical findings in 26 (96.2%). At surgery, 17 patients presented vegetations in the prosthesis and 11 had an abscess in the valvular ring. Bioprosthesis were used as valvular replacement in 27 patients (96,4%). Immediate mortality was 28,5% (8 patients), one death occurring later. An analysis of the association between death, time from onset of the endocarditis, surgical conditions and result of the cultures was carried out by the Chi-Squared (χ2) test. We conclude that the clinical preoperative conditions influence decisively the surgical results. Surgery under emergency conditions has the poorest results because of the patient's more critical condition: the more premature cases of endocarditis are also the more severe. Manipulation of infectious foci in patients with a valvular prosthesis should be careful and preceded by antibiotic administration. The longterm evolution of the surviving patients demonstrated significant functional class improvement.
endocarditis; heart valves prosthesis