A Retrospective Review: Significance of Vegetation Size in Injection Drug Users with Right-Sided XXXX .

@entity1 @entity3256 @entity295 @entity712 @entity326 @entity794 @entity47 @entity582 @entity204 @entity884
BACKGROUND: Previously described prognostic markers in @entity884 ( @entity884 ) include @entity47 size >= 1cm, fever for more than three weeks, @entity712 and severe @entity295 . This study aimed to evaluate effectiveness of medical therapy for vegetations >= 1cm and explore determinants of outcome in a representative population of intravenous drug users (IDUs) at a metropolitan Australian health service. METHODS: Retrospective review of consecutive IDUs presenting to our institution with native-valve @entity884 (by modified Duke criteria) over six years (2005-2011). Data recorded included echocardiographic estimation of maximal @entity47 diameter (classified as < or >= 1cm). Relationships between @entity47 size and specified outcomes of @entity204 , @entity326 , recurrence and relapse were examined by Chi-squared testing. RESULTS: Of 49 episodes five (10%) were managed surgically and a further four (8%) were lost to follow-up and excluded from the analysis. Of the remaining 40 evaluable medically treated @entity1 (median age 28, range 20-55), 37 (93%) cultured @entity3256 -sensitive @entity794 and all had tricuspid valve involvement. Of 24 with vegetations >= 1cm, three died (mortality 13%) compared with one (6%) in 16 medically treated @entity1 with vegetations <1cm (p=0.63). A Pittsburgh (PITT) @entity582 score of >= 4 at presentation was associated with a mortality of 24% (four of 17 @entity1 died) compared with 0 in 23 @entity1 with PITT scores <4 (p=0.026). CONCLUSION: Medical therapy alone can be effective for @entity884 when large vegetations are present. However a high @entity295 score at presentation may increase risk of @entity204 . Larger studies are required to determine optimal indications for early surgical intervention.
