What happens to vegetation following successful therapy ?
- It regresses almost completely and become sterile
- It regresses about 50 % volume but continue to harbor live viable bacteria
- Gets sterile but does not regress ,
- Vegetation vanishes completely .Gets dissolved circulation as micro particles.
- Appears slightly bulky.
Each of the above statement can be true in different patients at / different times. However No 1, is generally the dominant theme.
- Most of the small vegetations disappear fully.
- Large vegetations (>2 cm) almost never disappear fully .
- Fungal vegetation is notoriously known for a long haul battle
- Systemic embolism is an important mode of vegetation clearance from heart.
- Size of vegetation is an independent indication for surgery .
- Combination of vegetation with super added layer of thrombus is common.The thrombus lyses in due course , mimicking thrombus regression.
- Paradoxically healed vegetations may appear dense in 2 D echocadiography ,which may be wrongly interpreted as a growing vegetation.
- The risk of recurrent vegetation formation remains till the raw area is completely endothelised.Hence antibiotics are given up to 4-6 weeks.
Persistent culture negativity may be a good index for successful management . But a negative blood culture does not in any – way imply absence of vegetation.