Everything about Infective Endocarditis Surgery

Imagine that you have had a fever for several days, feel very tired, and feel lifeless... We usually think that this is probably a viral fever. But sometimes, behind such symptoms, there may be a much more serious story hidden. That is, a severe infection that affects the heart itself. Today, we are going to talk about such a serious and life-threatening condition as 'Infective Endocarditis' and when it requires surgery. Although this is a bit complicated topic, I will explain it to you in a very simple way, so that you can understand it.

Simply put, what is Infective Endocarditis?

This name sounds a little scary, doesn't it? But let's keep it simple. Our blood travels throughout our bodies through our veins. Sometimes germs like bacteria or fungi can enter this blood system. Normally, our body's immune system fights them off and destroys them.

But sometimes these germs, traveling through the blood, reach the heart valves, where they stick and take root, causing a major infection. That's what we call ``Infective Endocarditis''.

Think of the valves in our hearts as gates. They need to open and close properly so that blood can flow in only one direction. A healthy heart valve is very smooth, so germs can't stick to it easily. But if a person's heart valve is weak from birth or has been damaged by another disease, its surface is rough. Like an old wall. Those rough spots are more likely to trap germs in the blood.

Germs can enter our bodies during routine dental procedures, such as tooth extractions, dental procedures, and endoscopy. While this may not be a big problem for a healthy person, it can be dangerous for someone with heart valve problems.

How does this situation affect your health?

Once a germ gets lodged in a heart valve, it doesn't just stay there. The germs divide, multiply, and form large colonies. In medicine, we call these clumps of germs vegetations .

These `(vegetations)` are doing a very dangerous job.

1. Damage to the valves: These bacteria release chemicals, similar to enzymes that are used to digest food. These are very strong. They slowly dissolve and eat away at the delicate tissue of the heart valve. Then the valve does not close properly, which means it starts to leak. We call this valvular regurgitation.

2. Heart Failure: When a valve leaks, the heart has to work harder than usual to pump blood to the body. It's like pumping water from a leaky bucket. When you work under this extra load over time, the heart can become weak and eventually develop heart failure.

3. Blood clots break off and block: Sometimes small pieces of the germs I mentioned, called `(vegetations),' break off and travel throughout the body with the blood. We call this broken piece `(embolus).' This is like a piece of moss in a river breaking off and floating in the water. If this blood clot breaks off and gets stuck in a blood vessel in the brain, it can cause paralysis `(stroke). If it gets stuck in a vein in the lungs, it can cause a dangerous condition called `(pulmonary embolism). Also, a blood vessel leading to an organ in the abdomen or an arm or leg can become blocked, causing `(ischemia).'

How is it treated? Is surgery necessary?

Treatment depends on the type of germ that caused the infection and how serious the condition is.

• Antibiotics: If the disease is detected early, there are cases where the infection can be completely cured with just strong antibiotics given intravenously for several weeks.
• Surgery: However, if you have vegetations on your heart valve, if the valve is severely damaged, or if you have a prosthetic valve that was previously implanted, antibiotics alone may not be enough. In such cases, surgery may be necessary.

How soon does the surgery need to be done?

The timing of the surgery depends on how serious your condition is. Some patients may need to have surgery within a few days of diagnosis. This is an emergency surgery. Let's look at the table below to see when emergency surgery is needed.

Are there times when surgery is delayed?

Yes, sometimes doctors decide to delay the surgery a bit. There are two main reasons for that.

1. Brain-related complications: If a piece of the germ has broken off and blocked a blood vessel in the brain (ischemic stroke) or if there is bleeding in the brain (intracranial hemorrhage), it is risky to perform major heart surgery right away. This is because blood-thinning medications given during surgery can increase bleeding in the brain. Therefore, surgery is performed only after the brain has stabilized.

2. The condition is not that serious: If the infection is not severe and the risk of complications is low, the doctor will first give you a full course of antibiotics. Then, the infection will be completely gone, and you can go into surgery with a clean body. It will also give you a good amount of time to plan the surgery.

How do doctors decide if I need surgery?

This is not a decision made by one doctor alone. Cardiologists and cardiac surgeons come together and make this decision based on international guidelines. They perform several tests for that.

• Blood tests: To find out exactly what bacteria or fungus is causing the infection.
• Echocardiogram: This is a scan of the heart. It looks at the heart valves and can tell if there are any vegetations, how large they are, and how much damage has been done to the valves. The one done over the chest is called a transthoracic echocardiogram (TTE). Sometimes, to get a better look, a transesophageal echocardiogram (TEE) is done through the mouth.
• CT scan: This test helps to see if the infection has caused complications in other parts of the body.

What happens during the surgery?

The type of surgery performed depends on the nature of the damage to your heart valve. The surgeon may do one or more of the following:

• Debridement: The first step is to thoroughly clean and remove all infected and dead tissue.
• Valve repair: If the damage is not too severe, an attempt will be made to repair the existing valve.
• Valve reconstruction: Sometimes, part of the valve is removed and a piece of the membrane surrounding the heart (pericardium) is taken and transplanted into place to rebuild the valve.
• Valve replacement: If the damage to the valve is so severe that it cannot be repaired, the valve is completely removed and an artificial valve is implanted in its place.

What happens after the surgery? Are there any risks?

Like any major surgery, this surgery has some risks. There are risks such as bleeding, irregular heartbeat (arrhythmia), blood clots, paralysis, and re-infection of the newly implanted valve. But if a doctor has decided that you need surgery, it means that the benefits of having surgery are much greater than not having it.

After the surgery, you will need to stay in the intensive care unit (ICU) for a few days. Then you will be transferred to a regular ward. You will need to take antibiotics intravenously or in pill form for several weeks to completely eliminate any remaining germs in your body. You will also need to get plenty of rest after you go home. It is normal to feel tired and sore. It can take several months to fully recover.

What time should I see the doctor after the surgery?

You should take extra care of your body after you go home. It's important to recognize any complications as soon as possible. If you experience any of the symptoms below, you should contact your doctor immediately .