Right-sided bacterial endocarditis. New concepts in the treatment of the uncontrollable infection

Our experience with 25 patients with right-sided bacterial endocarditis is described; 23 were heroin addicts. The clinical manifestations of right-sided endocarditis are primarily related to septic pulmonary embolism.When the infection was due to gram-positive cocci, antibiotics always cured the patient. However, if the infection was due to Pseudomonas aeruginosa resistant to therapy, excision of the infected tricuspid or tricuspid and pulmonary valves without prosthetic replacement effected a cure. Nine out of 10 long-term survivors treated in this manner have had no significant hemodynamic difficulties.Antibiotic therapy must be limited to six weeks or less, because if the infection persists beyond this period it may also spread to the left side of the heart, where valve excision without replacement is impossible.