Site of entry and surgical timing in infective endocarditis

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Infective endocarditis affects native cardiac structures (valves, atrial, and ventricular endocardium) or surgically implanted devices (valve prosthesis, endocardial electrodes). The first description of this condition belongs to Jean Francois Fernel, a French doctor, in 1554.1
More than 300 years later, in 1885, Sir William Osler further defined the condition. The key pathogenic element to define infective endocarditis is the demonstration of the infectious organism, isolation and antibiotic susceptibility test of which directs the specific antimicrobial treatment, its duration, and the prognosis of the condition. Infective endocarditis has an occurrence of three to nine cases per 100 000 people per year in the Western countries and a male-to-female ratio of 2 : 1.2 The highest prevalence is found in patients with valve prosthesis and intracardiac devices, in patients with uncorrected cyanotic congenital heart conditions, or with previous endocarditis. Notwithstanding the improvement of current treatment, infective endocarditis has a recurrence rate between 5 and 10%3 and still carries a high mortality rate.4
Hence, the rationale for the search and the cure of the site of entry of endocarditis is also important in the prevention of the recurrence of the disease.

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