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partial pericardiectomy the approach can be either by a left anterolateral thoracotomy or median sternotomy for pyogenic pericarditis with
pericardial window through left antero lateral thoracotomy a small left antero lateral thoracotomy is done through the 5 intercostal space a
sub xyphoid pericardial window it could be done under local or general anaesthesia a small vertical midline incision is made over the xyphoid
prevention of endocardial infection by the use of antimicrobial agents although desirable is not always possible by identifying the patients at
pericardiocentesis this is usually done by the cardiologist it is better done with ecg and haemodynamic monitoring subxyphoid route is preferred
relapse of infective endocarditis usually occurs within two months of the discontinuation of antimicrobial therapy the relapse rate for patients with
cardiac surgical intervention has an increasingly important role in the treatment of intracardiac complications of endocarditis retrospective data
extra cranial masintrathoracic or intra-abdominal mas are often asymptomatic until leakage or rupture occurs most extracranial mas ecmas will rupture
the reported occurrence of icmas is 12 per cent to 5 per cent of cases streptococci and saureus account for 50 per cent and 10 per cent of cases
they result from septic embolization of vegetations to the arterial vasa vasorum or the intraluminal space with subsequent spread of infection
splenic infarction is a common complication of left-sided ie 40 per cent of cases only 5 per cent of patients with splenic infarction will develop
occur in 10 per cent to 40 per cent of all native-valve ie and complicates aortic ie more commonly than mitral or tricuspid ie periannular infection
systemic embolization occurs in 22 per cent to 50 per cent of cases of ie emboli often involve major arterial beds including lungs coronary arteries
pericardial effusion indications for surgery pericardial effusion may be the result of peiicarditis due to infection autoimmune disease or
in native-valve ie acute chf occurs more frequently in aortic-valve infections 29 per cent than with mitral 20 per cent or tricuspid disease 8 per
within a week after initiation of effective antimicrobial therapy almost 75 per cent of patients with ie including those with pve are afebrile and 90
special studies to diagnose ie caused by fastidious bacteria and other organisms must be performed serological studies thereafter unless clinical or
two major objectives must be achieved to treat ie effectively the infecting micro-organism in the vegetation must be eradicated also invasive
results pericardiectomy used to have a mortality of 10-15 per cent in the earlier era at present it is around 3 to 5 per cent and does not
median sternotomy approach the preferred approach these days is through a median sternotomy pericardiectoiny proceeds in the same way as done
urine analysis - microhematuria with or without proteinuria may be seenecg - all patients with suspected ie should have baseline and follow up ecg
echocardiographic evaluation should be performed in all patients with clinically suspected ie including those with negative blood cultures not
in patients who have not received prior antibiotics and who will ultimately have blood culture positive endocarditis it is likely that 95 - 100 per
bull blood cultures are critical in the diagnosis and management of ie bull obtain blood cultures before starting antimicrobial therapy whenever
left antero lateral thoracotomy approach arterial and central venous pressure monitoring lines are placed a left antero lateral thoracotomy is