Management of infective endocarditis.

Correspondence to: Dr Gilbert Habib, Hôpital Timone, Cardiologie B, Boulevard Jean Moulin, 13005 Marseille, France; [email protected] _________________________ I nfective endocarditis (IE) is a disease that is continually changing, with new high risk patients, new diagnostic procedures, the involvement of new microorganisms, and new therapeutic methods. Despite knowledge of these changes, and considerable improvements in diagnostic and therapeutic strategies, IE is still a severe disease. The high morbidity and mortality rate of IE is the consequence of both the destructive valvar lesions causing valve regurgitation and heart failure, and the valvar vegetations with their high embolic potential. Although the incidence of IE is relatively stable, those patients affected by the disease are older and sicker, and the comorbidity rate is high. As soon as the diagnosis of IE is suspected, the physician is faced with four specific problems: c First, the diagnosis of IE is still difficult and is frequently delayed, causing progressive and irreparable valvar damage. c Second, IE is still associated with high in-hospital mortality, ranging from 16–25%, and high incidence of embolic events, ranging from 10–49%, potentially the source of severe complications and sequelae. c Third, the optimal therapeutic strategy in these patients is still to be defined and may vary in the individual patient. c Fourth, some patients present with specific features or complications and need a specific management. These four issues will be addressed here.