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November 23, 2011 3:41 pm
Modern day cardiology can do wonders. It can revive a sinking patient in cardiogenic shock with IABP , LV assist , multivessel angioplasty and bring back life . On the other hand , a young man with an infected mitral valve who is put on intensive antibiotic regimen , progressively deteriorates throws an emboli into brain , raise his urea creatinine , cardiac failure worsens and finally succumbs .
This is a clear case of failure of medical therapy in infective endocarditis . It is almost certain surgery would have saved him .
Why the delay ?
So the question that is been debated for so long is “When to intervene with surgery in IE” ?
While we show extreme urgency for ACS , the same is not shown with IE.This is going to change in the future .Thanks to the EASE trial (Early surgery in endocarditis ) This land mark study from Korea is likely to revolutionise the way we will look into the problem of infective endocarditis. It was presented in the just concluded AHA annual scientific sessions in Orlando
This was our observation too . The issue was discussed in the year 2008 .It reminds me , every learned thought or opinion is in fact a paper but unfortunately modern science does not accept a fact without evidence of a study . Until then it remains as a crap !
I am glad to note genuine concepts will some day get ratified . Kudos to the Korean team.It is a great study to do with many ethical issues.
Click below to read the related article
Link to EASE Trial http://www.theheart.org/article/1313215.do
Next question on the cards
Should there be a time window above which medical therapy should be deemed (Doomed !) to have failed , so that the patient becomes a default candidate for surgery.
Posted by dr s venkatesan
Categories: Cardiology - Clinical, cardiology -Therapeutics, Clinical cardiology, Infrequently asked questions in cardiology (iFAQs), myocardial disease
Tags: contraindication for doing coroanry angiogram, duke criteria for infective endocarditis, early surgical management of infective endocarditis, ease trial aha 2011, infective endocarditis, surgery vs medical managment, vancomycin
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