320 The infectious endocarditis with aortic localization. A surgical emergency

Introduction The course of aortic post endocarditic incapacity is unpredictable. It requires a particular management and an early or urgent surgery because of the subsequent serious complications. The aim of our retrospective study is to review the epidemiological and clinical features and to emphasize on the early of this clinical entity. Material and method Forty seven patients was admitted in our heart department for infectious endocardite (I.E) with isolated aortic location. Patients with other localisations of I.E were withdrawn. Patients were separated in two groups according to availability of the cardiac surgery in our institution. - A first group of 22 patients hospitalized between 1989 and 1995 where cardiac surgery was not available and - The second group of 25 patients hospitalized between 1997 and 2009 where cardiac surgery was available The IE diagnosis was made according to the modified criteria DUCKE. Results The average of age was 32 ± 12 years (extremes 16 – 67 years) with 77% of males. The previous cardiac state is documented in 45% of the cases. Rheumatoid arthritis is found in 86% of the cases. An etiology was fund in 43% of cases, 89% out of them had dental etiology. Vegetations were found in 100% of the cases at the echocardiagraphic exam. The left ventricle is of normal size or dilated. DOPPLER exam showed the aortic leak were of grade III or IV in all cases. Bloodcultures were positive in 27% in the 1st group and 60% in the second. A negative coagulase staphylococcus was found in 71% of the cases. The course of the disease of the 51% of the patients with left ventricular impairment and the 11% of the cerebral embolism was the death. Although mortality is decreasing (77% in the 1st group and 48% in the second), this mortality remains high in our population. Conclusion Strong mortality is the burden of aortic localization. If in developed countries, it is below 30% due to early surgery, much remains to make in emergent countries.