When do you call a infected heart as healed ?
Should the vegetation disappear to call it a cure ?
Vegetation’s rarely disappear following treatment . Very small vegetation may dissolve – 20% . Many times it regress in size .
Often our aim should be restricted to sterilise the vegetation. This invariably happens in most of the patients who receive complete course of antibiotic. But healing and sterilizing is not enough in many vulnerable patients.If the vegetation is large the embolic risk is still there even with a healed vegetation.
So if there is a relatively large (>1.5cm) vegetation it is always better to remove by surgery.
Interventional techniques may soon allow capturing these vegetation by basket catheters .When technology is there to retrieve small bits of a thrombus inside a coronary artery it should be possible to remove a large vegetation with temporary aortic filters in place.
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Dr.S.Venkatesan MD 