Cirurgia conservadora da endocardite bacteriana aguda da valva tricúspide

Costa, Iseu Affonso da; Mulaski, José Carlos; Lopes, Luiz Roberto Macedo; Cunha, Cláudio Pereira da; Souza, Admar Moraes de

doi:10.1590/S0102-76381988000200008

Resumos

É relatado o caso de 1 paciente que apresentou endocardite aguda da valva tricúspide pós-aborto, cujo agente causal era o S. aureus. Como não houvesse resposta favorável ao tratamento antibiótico (gentamicina, vancomicina e oxacilina), optou-se pela intervenção, vinte dias após a internação. Foi praticada excisão de uma vegetação única e do tecido valvar adjacente, na comissura ântero-posterior e plicatura anular. O resultado foi favorável, com cura clínica. O exame ecocardiográfico confirmou a presença da vegetação no pré-operatório e o funcionamento conservado da valva, após a plastia. O tratamento cirúrgico, com retirada do tecido infectado e preservação da valva constitui uma alternativa aplicável a certos casos de endocardite aguda das valvas atrioventriculares.

endocardite bacteriana; valvas cardíacas

One case of acute bacterial endocarditis of the tricuspid valve caused by S. aureus and following a septic abortion is presented. Surgical treatment was indicated after failure of antibiotics. Operation consisted of excision of a large vegetation adherent to the anterior and posterior cusps at the commisure and of the affected valvar tissue. Annular plicature at the segment corresponding to the posterior cuspid was employed to maintain competence. Clinical result was very satisfactory with resolution of sepsis. Dopplerecocardiography revealed the presence of the vegetation before the operation and showed a small regurgitation after valvoplasty. Conservative operation upon the atrioventricular valves must be kept in mind as an alternative in the treatment of acute bacterial endocarditis.

bacterial endocarditis; heart valves

RELATOS DE CASO

Cirurgia conservadora da endocardite bacteriana aguda da valva tricúspide

Conservative operation for bacterial endocardites of the tricuspide valve

Iseu Affonso da Costa^I; José Carlos Mulaski^II; Luiz Roberto Macedo Lopes^II; Cláudio Pereira da Cunha^III; Admar Moraes de Souza^II

^IDo Departamento de Cirurgia da Universidade Federal do Paraná

^IIDo Hospital das Clínicas da Universidade Federal do Paraná

^IIIDo Departamento de Clínica Médica da Universidade Federal do Paraná

^{Endereço para separatas} Endereço para separatas: Iseu A. Costa Rua Carmelo Rangel, 816 80420 Curitiba, PR, Brasil

RESUMO

É relatado o caso de 1 paciente que apresentou endocardite aguda da valva tricúspide pós-aborto, cujo agente causal era o S. aureus. Como não houvesse resposta favorável ao tratamento antibiótico (gentamicina, vancomicina e oxacilina), optou-se pela intervenção, vinte dias após a internação. Foi praticada excisão de uma vegetação única e do tecido valvar adjacente, na comissura ântero-posterior e plicatura anular. O resultado foi favorável, com cura clínica. O exame ecocardiográfico confirmou a presença da vegetação no pré-operatório e o funcionamento conservado da valva, após a plastia. O tratamento cirúrgico, com retirada do tecido infectado e preservação da valva constitui uma alternativa aplicável a certos casos de endocardite aguda das valvas atrioventriculares.

Descritores: endocardite bacteriana, cirurgia; valvas cardíacas, cirurgia.

ABSTRACT

One case of acute bacterial endocarditis of the tricuspid valve caused by S. aureus and following a septic abortion is presented. Surgical treatment was indicated after failure of antibiotics. Operation consisted of excision of a large vegetation adherent to the anterior and posterior cusps at the commisure and of the affected valvar tissue. Annular plicature at the segment corresponding to the posterior cuspid was employed to maintain competence. Clinical result was very satisfactory with resolution of sepsis. Dopplerecocardiography revealed the presence of the vegetation before the operation and showed a small regurgitation after valvoplasty. Conservative operation upon the atrioventricular valves must be kept in mind as an alternative in the treatment of acute bacterial endocarditis.

Descriptors: bacterial endocarditis, surgery; heart valves, surgery.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Entregue para publicação em 30 de outubro, 1988.

Trabalho realizado no Departamento de Cirurgia da Universidade Federal do Paraná. Curitiba, PR, Brasil.

1 ARBULU, A.; THOMS, N. W.; CHISCANO, A.; WILSON, R. F. - Total tricuspid valvulectomy without replacement in the treatment of Pseudomonas endocarditis. Surg. Forum, 22: 162-164, 1971.
2 CHANDRARATNA, P. A. N.; REAGAN, R. B.; IMAIZUMI, T.; LANGEVIN, E.; ELKINS, R. C. - Infective endocarditis cured by ressection of a tricuspid valve vegetation. Ann. Int. Med, 89 (4): 517-518, 1978.
3 FLEISHER, A. G.; DAVID, I.; MOGTADER, A.; HUTCHINSON, J. E. - Mitral valvuloplasty and repair for infective endocarditis. J. Thorac. Cardiovasc. Surg, 93 (2): 311-315, 1987.
4 GAMMAGE, M. D.; LITTLER, W. A.; ABRAMS, L. D. - Conservative surgery of the mitral valve in bacterial endocarditis. Thorax, 39 (11): 868-871, 1984.
5 GRAHAM, D. Y.; REAL, G. J.; MARTIN, R.; MORTON, J.; KENNEDY, J. H. - Infective endocarditis in drug addicts: experiences with medical and surgical treatment. Circulation, 48 (Supl. 3): 37-41, 1973.
6 HUGHES, C. F. & NOBLE, N. - Vegetectomy: an alternative for infective endocarditis of the atrioventricular valves in drug addicts. J. Thorac. Cardiovasc. Surg, 95 (5): 857-861, 1988.
7 HARTYÁNSKY, I. L.; LOSÁDIK, K.; HÜTL, T. - Successful surgical management of mitral valve endocarditis in a 13-month-old child. J. Thorac. Cardiovasc. Surg, 96 (5): 831-832, 1988.
8 JAGGER, S. D.; McCOUGHAN, B. C.; PWSEY, C. G. K. - Tricuspid valve endocarditis cured by excision of a single vegetation. Am. Heart J, 112 (3): 626-627, 1986.
9 JUNG Jr., Y.; SAAB, S. B.; ALMOND, C. . - The case for early surgical treatment of left-sided primary infective endocarditis: a collective review. J. Thorac. Cardiovasc. Surg, 70 (3): 509-518, 1975.
10 KAY, J. H.; BERNSTEIN, S.; FEINSTEIN, D.; BIDDLE, M. - Surgical cure of Candida abbicans endocarditis with open-heart surgery. N. Engl. J. Med, 264 (18): 907-910, 1961.
11 MANHAS, D. R.; MOHRI, H.; HASSEL, E. A.; MERENDINO, K. A. - Experience with surgical management of primary infective endocarditis: a collected review of 130 patients. Am. Heart J, 84 (6): 738-747, 1972.
12 MILLS, S. A. - Surgical management of infective endocarditis. Ann. Surg, 195 (4): 367-383, 1982.
13 SIMBERKOFF, M. A.; ISOM, W.; SMITHIVAS, T. - Two-stage tricuspid valve replacement for mixed bacterial endocarditis. Arch. Int. Med, 133 (2): 212-216, 1974.
14 TOUROFF, A. S. W. & VESSEL, H. - Subacute Streptococcus viridans endarteritis complicating patent ductus arteriosus. JAMA, 115 (15): 1270, 1940.
15 WALLACE, A. G.; YOUNG, Jr., Y.; OSTERHOUT, S. - Treatment of acute bacterial endocarditis by valve excision and replacement. Circulation, 31 (3): 450-453, 1965.
16 WRIGHT, J. S. & GLENMIE, J. S. - Excision of tricuspid valve with later replacement in endocarditis of drug addiction. Thorax, 33 (4): 518-519, 1978.
17 YEE, E. S. & ULLYOT, D. J. - Reparative approach for right-sided endocarditis: operative considerations and results of valvuloplasty. J. Thorac. Cardiovasc. Surg, 96 (1): 133-140, 1988.

Endereço para separatas:

Iseu A. Costa

Rua Carmelo Rangel, 816

80420 Curitiba, PR, Brasil

Datas de Publicação

Publicação nesta coleção
17 Fev 2011
Data do Fascículo
Ago 1988

Histórico

Recebido
30 Out 1988

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1 ARBULU, A.; THOMS, N. W.; CHISCANO, A.; WILSON, R. F. - Total tricuspid valvulectomy without replacement in the treatment of Pseudomonas endocarditis. Surg. Forum, 22: 162-164, 1971.

[2] 2 CHANDRARATNA, P. A. N.; REAGAN, R. B.; IMAIZUMI, T.; LANGEVIN, E.; ELKINS, R. C. - Infective endocarditis cured by ressection of a tricuspid valve vegetation. Ann. Int. Med, 89 (4): 517-518, 1978.

[3] 3 FLEISHER, A. G.; DAVID, I.; MOGTADER, A.; HUTCHINSON, J. E. - Mitral valvuloplasty and repair for infective endocarditis. J. Thorac. Cardiovasc. Surg, 93 (2): 311-315, 1987.

[4] 4 GAMMAGE, M. D.; LITTLER, W. A.; ABRAMS, L. D. - Conservative surgery of the mitral valve in bacterial endocarditis. Thorax, 39 (11): 868-871, 1984.

[5] 5 GRAHAM, D. Y.; REAL, G. J.; MARTIN, R.; MORTON, J.; KENNEDY, J. H. - Infective endocarditis in drug addicts: experiences with medical and surgical treatment. Circulation, 48 (Supl. 3): 37-41, 1973.

[6] 6 HUGHES, C. F. & NOBLE, N. - Vegetectomy: an alternative for infective endocarditis of the atrioventricular valves in drug addicts. J. Thorac. Cardiovasc. Surg, 95 (5): 857-861, 1988.

[7] 7 HARTYÁNSKY, I. L.; LOSÁDIK, K.; HÜTL, T. - Successful surgical management of mitral valve endocarditis in a 13-month-old child. J. Thorac. Cardiovasc. Surg, 96 (5): 831-832, 1988.

[8] 8 JAGGER, S. D.; McCOUGHAN, B. C.; PWSEY, C. G. K. - Tricuspid valve endocarditis cured by excision of a single vegetation. Am. Heart J, 112 (3): 626-627, 1986.

[9] 9 JUNG Jr., Y.; SAAB, S. B.; ALMOND, C. . - The case for early surgical treatment of left-sided primary infective endocarditis: a collective review. J. Thorac. Cardiovasc. Surg, 70 (3): 509-518, 1975.

[10] 10 KAY, J. H.; BERNSTEIN, S.; FEINSTEIN, D.; BIDDLE, M. - Surgical cure of Candida abbicans endocarditis with open-heart surgery. N. Engl. J. Med, 264 (18): 907-910, 1961.

[11] 11 MANHAS, D. R.; MOHRI, H.; HASSEL, E. A.; MERENDINO, K. A. - Experience with surgical management of primary infective endocarditis: a collected review of 130 patients. Am. Heart J, 84 (6): 738-747, 1972.

[12] 12 MILLS, S. A. - Surgical management of infective endocarditis. Ann. Surg, 195 (4): 367-383, 1982.

[13] 13 SIMBERKOFF, M. A.; ISOM, W.; SMITHIVAS, T. - Two-stage tricuspid valve replacement for mixed bacterial endocarditis. Arch. Int. Med, 133 (2): 212-216, 1974.

[14] 14 TOUROFF, A. S. W. & VESSEL, H. - Subacute Streptococcus viridans endarteritis complicating patent ductus arteriosus. JAMA, 115 (15): 1270, 1940.

[15] 15 WALLACE, A. G.; YOUNG, Jr., Y.; OSTERHOUT, S. - Treatment of acute bacterial endocarditis by valve excision and replacement. Circulation, 31 (3): 450-453, 1965.

[16] 16 WRIGHT, J. S. & GLENMIE, J. S. - Excision of tricuspid valve with later replacement in endocarditis of drug addiction. Thorax, 33 (4): 518-519, 1978.

[17] 17 YEE, E. S. & ULLYOT, D. J. - Reparative approach for right-sided endocarditis: operative considerations and results of valvuloplasty. J. Thorac. Cardiovasc. Surg, 96 (1): 133-140, 1988.