Infective Endocarditis: Risks, Treatments, and Recovery Insights

Infective endocarditis

Hello, Doctor.
Since the attending physician explained my mother's condition in front of other family members, I couldn't ask some questions.
I would like to know your experience regarding her situation.
My mother (56) has been diagnosed with infective endocarditis.
Initially, it was planned to administer antibiotics for a few days before performing surgery to replace two heart valves (the aortic and mitral valves).
However, after a CT scan of the brain, an aneurysm and some vascular malformations were discovered.
The attending physician mentioned that surgery would be risky due to the potential for cerebral hemorrhage, so the plan is to address the brain issues before proceeding with heart surgery.
Otherwise, even if the heart condition is treated, there is a risk of her becoming a vegetative state, which the physician does not want.
The attending physician indicated that if her heart deteriorates to a point where immediate surgery is necessary, they would proceed, but this would carry risks of stroke and vegetative state.
Currently, she is receiving antibiotic treatment.
After discussions between the attending physician and the neurosurgeon, it was mentioned that some aneurysms might respond to antibiotic therapy.
Over the past two days in the ICU, my mother's blood pressure has been stable (she has hypertension), but her heart rate has been elevated (120-165).
The nurses indicated that they have started medication to control it, but it will take time to stabilize.
I would like to ask the following questions:
1.
Can endocarditis lead to the formation of aneurysms?
2.
Can antibiotics treat aneurysms? I found information online stating that this has not been confirmed in the medical community.
3.
If surgery is needed to address the aneurysm, how long should we wait for the patient to recover before replacing the heart valves? Both are major surgeries, so they likely cannot be performed back-to-back.
4.
What is the success rate of replacing two heart valves?
5.
If both the aneurysm and heart valve replacements are successful, does my mother have a chance to return to a quality of life similar to that of a normal person, excluding the need for long-term medication (planning to use a mechanical valve)?
6.
In cases of severe heart failure and hypertrophy, is there a chance for recovery after successfully completing the valve replacement surgery? If recovery is possible, will it be complete or partial?
7.
If all surgeries go smoothly, based on your experience and that of the medical community, what are the chances of such a patient living beyond 5 or 10 years?
8.
If during surgery it is discovered that it may lead to a vegetative state or stroke, is there a mechanism similar to DNR (Do Not Resuscitate) to choose not to resuscitate? I have discussed this with my mother, and I personally do not wish for her to be resuscitated in such a situation, especially if some emergency treatments would be ineffective but cause significant suffering.
My mother agrees with this.
9.
Since my mother is currently intubated, I would like to know if there is a point after which she would need to undergo a tracheostomy if the tube is not removed.
What would be the consequences of not having a tracheostomy? If she does undergo a tracheostomy, after successful surgery, is there a chance it can be removed? Based on your experience, how likely is it that the tracheostomy can be removed?
Thank you, Doctor.

Ms. Chen, 20~29 year old female. Ask Date: 2019/03/14

Dr. He Dongjin reply Cardiology

Hello, endocarditis can lead to aneurysms.
Antibiotics may be able to treat aneurysms caused by endocarditis, but the time required for a patient to receive a prosthetic valve depends on each patient's recovery status, making it difficult to determine.
The success rate for placing two prosthetic valves is currently over 90%.
If the surgery goes smoothly, there is a chance to recover to a quality of life similar to that of a normal person.
Patients with severe heart failure have a chance to recover after successfully undergoing prosthetic valve surgery, with a high likelihood of living more than 5 to 10 years.
During surgery, complications such as becoming comatose or having a stroke may arise; currently, there is no option for a "do not resuscitate" mechanism.
In fact, a tracheostomy is more comfortable than intubation, and it is advisable to perform a tracheostomy earlier.
This does not affect the overall prognosis or future recovery.
Once the surgery is successfully completed, there is a significant chance of removing the tracheostomy, and the likelihood of removal is quite high.
Changhua Hospital cares about you.

Reply Date: 2019/03/14

More Info

Infective endocarditis (IE) is a serious condition characterized by the infection of the heart valves or the inner lining of the heart. It can lead to severe complications, including heart failure, embolic events, and, as in your mother's case, the formation of aneurysms. Let’s address your questions one by one, providing insights based on medical knowledge and clinical experience.

1. Does infective endocarditis cause aneurysms?
Infective endocarditis can lead to the formation of mycotic aneurysms, which are aneurysms that occur due to infection. The bacteria can invade the arterial wall, leading to localized weakening and dilation. While not all cases of IE result in aneurysms, it is a recognized complication.

2. Can antibiotics treat aneurysms?
Antibiotics are essential for treating the infection associated with infective endocarditis, but they do not directly treat aneurysms. The role of antibiotics in managing aneurysms is primarily to control the underlying infection that may have contributed to their formation. There is no definitive evidence that antibiotics can shrink or resolve aneurysms.

3. How long should one wait after treating an aneurysm before performing heart valve surgery?
The timing of surgeries depends on the patient's overall condition and the stability of the aneurysm. Typically, once the infection is under control and the patient is stable, a multidisciplinary team will evaluate the risks and benefits of proceeding with heart surgery. This could take weeks to months, depending on individual recovery and the complexity of the cases involved.

4. What is the success rate of artificial valve replacement?
The success rate of valve replacement surgery is generally high, with studies showing that over 90% of patients experience significant improvement in symptoms and quality of life post-surgery. However, success rates can vary based on the patient's overall health, the presence of comorbidities, and the specific surgical technique used.

5. Will my mother be able to return to a normal quality of life after surgery?
Many patients who undergo successful valve replacement surgery can return to a good quality of life, especially if they adhere to their medication regimen and follow up with their healthcare providers. However, the extent of recovery can vary based on pre-existing conditions and the overall health status before surgery.

6. Can severe heart failure and hypertrophy improve after valve surgery?
Valve surgery can significantly improve heart function in patients with severe heart failure and hypertrophy, particularly if the heart failure is primarily due to valve dysfunction. While some patients may experience complete recovery, others may have partial recovery, depending on the duration and severity of their heart condition prior to surgery.

7. What are the long-term survival chances post-surgery?
Many patients with infective endocarditis who undergo successful surgery can live for many years, with studies indicating that a significant percentage survive beyond 5 to 10 years post-operation. Factors influencing long-term survival include the patient's age, overall health, and the presence of other medical conditions.

8. Is there a mechanism like DNR for surgical decisions?
Yes, patients and families can discuss advance directives, including Do Not Resuscitate (DNR) orders, with their healthcare team. These discussions should occur before surgery, allowing the medical team to understand the patient's wishes regarding aggressive treatment in the event of complications.

9. What happens if intubation is prolonged?
Prolonged intubation may lead to complications such as tracheal injury or the need for a tracheostomy if the patient cannot be extubated safely. A tracheostomy can be reversed later, but the timing and feasibility depend on the patient's recovery and overall condition.

In conclusion, your mother's situation is complex and requires careful management by a multidisciplinary team. It is crucial to maintain open communication with her healthcare providers to understand the risks, benefits, and expected outcomes of her treatment plan. Each decision should be made with her best interests in mind, considering both her medical condition and her personal wishes.

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