[Infectious endocarditis surgically treated during the acute phase. 26 cases].

Twenty-six patients with infective endocarditis were operated upon during the active phase. The endocarditis was native in 24 cases and developed on cardiac valve prosthesis in 2 cases. Depending on the valve involved, the patients were divided into 3 groups: Ao (aortic valve, n = 13), M (mitral valve, n = 10) and T (tricuspid valve, n = 3). The overall mortality rate was 26% (group Ao 20%, group M 20%); death was due, in most cases, to haemodynamic failure. The duration of pre-operative antibiotic therapy, the functional stage of the disease and the cardiothoracic ratio had no influence on post-operative prognosis. In contrast, the presence of vegetations (notably on the aortic valve) at echocardiography and the pumping and aortic clamping times played a role in operative mortality. Twelve patients were followed up for a mean period of 23.9 months. They are all in stage I or II with significant decrease in cardiothoracic index. In Africa, where bacteriological facilities are often inadequate and cardiac valve diseases are diagnosed at a late stage, infective endocarditis is active in many cases. Under these conditions, early surgery is justified when heart failure is present and the infection is not clinically controlled.