083 Clinical and echocardiographic characteristics of multivalvular infective endocarditis

IntroductionThe multivalvular endocarditis is rare, frequently involving two valves, and is associated with bad prognosis.ObjectiveTo compare clinical, microbiological and in hospital prognostic of multivalvular infective endocarditis with single valve infective endocarditis.Methods and patientsThis is a retrospective study; included 225 patients admitted between 2001 and 2005 for management of infective endocarditis. Subsequently, our population was divided into two groups: Group 1: multivalvular patients (29 patients), Group 2: monovalvular patients (196 patients).ResultsGroup1's patients were younger. Most of patients of two groups had underlying heart disease, essentially rheumatic heart disease.In group1, there is more mitral insufficiency, more aortic insufficiency (p=0.002), but less aortic stenosis. Groups’ 1 patients have more mechanical valves prosthesis (p=0,004). The germ most frequently involved was the staphylococcus in case of multivalvular disease (46.7% vs 37.3%) and streptococcus in case of monovalvular disease (26.7% vs 38.2%), but without a significant difference in the both cases. The localization of vegetations in multi valvular IE were: mitro aortic in 25 cases.In the TTE, there are more vegetations in group 1 : (p=0,048). Vegetations with size between 10 and 15 mm are more frequent in the group 1(p=0,019). Valvular perforations are more frequent (p=0,070). Evolution to valvular abscess (p=0,414), and acute pericardial effusion (p=0,051) was more frequent in group 1.During their hospital period, urgent surgical indication was more frequent in the group 1(62, 1% vs. 51, 3%; p=0,279), with more frequent hemodynamic indication (72, 2% vs. 47%; p=0,049). Hospital mortality is higher in the group 1 (21, 4% vs. 17, 2%; p=0,586), but without a statistical significance.ConclusionMutivalvular endocarditis has specific characteristics: Staphylococcus is the more incriminated germ. It is associated to more complications, and necessitates more urgent surgery because of acute left heart failure