Is a patient with active infectious endocarditis, severe pulmonary hypertension due to sudden broken of a papillary muscle of mitral valve, septic shock, renal failure and recovery of cardiorespiratory arrest the last friday. Now he´s intubate and with sedative (midazolam) and suport drugs (levophed). Does he still has a chance?
Thanks
Dr. Ernesto Rodríguez
You should operate on him ASAP, that is the only chance he's got! In facts, that is the indication for emergency surgery! Good luck!
Hemodynamic crisis is an ABSOLUTE indication for emergency Surgery! Short-time attempt to improve hemodynamics before surgery is OK. While we would like for all endocarditis to be sterilized and stable before surgery, that is frequently only a wish, especially with chordal rupture, coronary or cerrabral embroli, etc. Shock=emergency
You have had the right advice already.
One point: In my experience, if the organism waqs sensitive to antibiotics, giving the starting dose and proceeding immediately to surgery never resulted in recurrent postoperative infection. Howeverm you must know that I always practised complete debgirement of all infected tissue followed by Bovine pericardial reconstruction as needed.
It is possible, and may be probable, that the patient has already developed irreversible shock. Therefore a short period of resuscitation is necessary and only if there is some evidence of reversibility in form of improvement in haemodynamics , urine output, peripheral temperature etc should surgery be attempted.
Good Luck
Incidentally , a trivia - its 'Infective' Endocarditis nd not Infectious.
The best time to operate a patient with infective endocarditis is definitely after the full course of antibiotic and complete healing of endocarditis. It turns out that this disease can occasioning serious damage occasionant multiple complications (cardiogenic shock, cardiac insuffisnce, septic emboli and impose treatment ... surgical emergency treatment but with poor results....
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