Multivalvular Infective Endocarditis Clinical Features, Echocardiographic Data and Outcomes

Little information is available concerning patients with multivalvular endocarditis (MVE) that simultaneously affects at least two cardiac valves. Current understanding of MVE is primarily based on sporadic case reports 6-9 and rarely on systematic retrospective investigation. Our aim was to investigate clinical and echocardiographic characteristics, microbiological profile, management and outcomes of multivalvular endocarditis in a Tunisian tertiary-care centre. This retrospective study included 225 patients admitted between 2001 and 2005 for the management of infective endocarditis as determined by the Duke criteria. Subsequently, they were divided into two groups: Group 1: multivalvular endocarditis patients (29 patients), Group 2: monovalvular endocarditis patients (196 patients). Group 1 patients were younger. Male sex was predominant in the two groups. Most of the patients of the two groups had underlying heart disease, essentially rheumatic heart disease. In group 1, there was more mitral insufficiency, more aortic insufficiency (p=0.002), but less aortic stenosis. Groups 2 patients had more mechanical valve prostheses (p=0,004) .The majority of the patients of the two groups have fever. The dental procedures are the most frequent infectious side entry in the two groups. The most frequently involved germ was the staphylococcus in the case of multivalvular disease (46.7% vs 37.3%) and streptococcus in the case of monovalvular disease (26.7% vs 38.2%), but without a significant difference. The localization of vegetations in multi valvular IE were: mitro aortic in 25 cases, Based on the TTE and the TEE, there were more vegetations in group 1 (p=0,048). Vegetations sized between 10 and 15 mm were more frequent in the group 1 (p=0,019). Valvular perforations (p=0,070), valvular abscess formation (p=0,414), and acute pericardial effusion (p=0,051) were more frequent in group 1. During their hospital period, urgent surgical indication was more frequent in group 1(62, 1% vs. 51, 3%; p=0,279), with more frequent hemodynamic indication (acute left heart failure) (72, 2% vs. 47%; p=0,049). Hospital mortality was higher in the group 1 (21, 4% vs. 17, 2%; p=0,586), but without a statistical significance. Our data suggest that complications of multi-valvular endocarditis, and those of uni-valvular endocarditis are similar except for heart failure. Heart failure is statistically more common in multi-valvular endocarditis but without great influence on mortality.