Influence of vegetation size on clinical outcome of right-sided XXXX .

@entity1 @entity340 @entity2259 @entity884
@entity884 involving right-sided valvular structures is largely a disease of intravenous drug abusers. The majority of these @entity1 respond to antibiotic therapy with clearing of their @entity2259 and preservation of their hemodynamic status. This study evaluated the prognostic value of echocardiographically determined vegetation size in 23 episodes of right-sided @entity340 in 21 @entity1 . Right-sided vegetations were visualized in 19 of 23 episodes (83 percent). Of these, a vegetation of 1.0 cm or greater was found in 11. No @entity1 with an echocardiographically determined vegetation size of less than 1.0 cm required surgery, whereas four of 11 (36 percent) of those episodes in which the vegetation size was 1.0 cm or greater required surgery for persistent pyrexia (p less than 0.05). In all @entity1 requiring surgery, a bioprosthetic tricuspid valve was placed at the time of initial surgery and in no @entity1 did early reinfection occur. This study reconfirms the benign prognosis of right-sided @entity340 . Further, although vegetations of less than 1.0 cm identify those @entity1 who will respond to medical therapy, echocardiographically documented vegetations of 1.0 cm or greater are associated with a significantly lower response rate to appropriate medical therapy. The association of fever that persists for more than three weeks in the absence of another source of infection with an echocardiographically demonstrable right-sided vegetation of 1 cm or more identifies those @entity1 who will require surgical intervention. Finally, tricuspid valve replacement can be performed at the time of initial surgery without undue concern for early reinfection or @entity340 .
