Contribution of echocardiography and immediate surgery to the management of severe XXXX from active @entity884 .

@entity1 @entity712 @entity338 @entity337 @entity884
The timing of surgery in @entity1 with severe @entity337 and left ventricular (LV) failure, particularly when associated with active @entity884 ( @entity884 ), is of the utmost importance. From July 1982 to May 1984, 34 @entity1 , aged 15 to 60 years, with severe @entity337 underwent immediate (within 24 hours of diagnosis) aortic valve surgery. All @entity1 were in New York Heart Association class IV for LV failure. Eighteen @entity1 had @entity712 . Decision for immediate surgery was based on the echocardiographic demonstration of diastolic closure of the mitral valve or of vegetations on the aortic valve. Premature closure of the mitral valve was demonstrated echocardiographically in 17 @entity1 , 13 of whom had diastolic crossover of LV and left atrial pressure tracings recorded at surgery. @entity884 of the aortic valve was confirmed at surgery in 29 @entity1 , 27 of whom had vegetations on echocardiography. Seven @entity1 required replacement of both aortic and mitral valves. Antibiotic therapy for @entity884 was started immediately after blood cultures were taken and continued for 4 to 6 weeks postoperatively. The mortality rate within 30 days of surgery was 6% for the group as a whole and 7% for those with @entity884 . Mean follow-up period for the 32 survivors was 10.6 months. There were 2 late deaths. No @entity1 had @entity338 or persistence of @entity884 . Procrastination in referral for surgery of these extremely ill @entity1 is not justified and is likely to be associated with higher risks of morbidity and mortality.
