**Introduction**

As experience grows in the diagnosis and management of cardiac infections, there has also been a greater recognition of the presenting acute and chronic comorbidities that can be used to predict short- and long-term outcomes. While certain populations, such as those with im‐ plantable cardiac devices such as pacemakers, defibrillators, and left ventricular assist devi‐ ces or those with advanced end-organ dysfunction, such as end-stage renal disease, have long since been recognized as being at high risk for poor outcomes, there is a growing recog‐ nition (as referenced above) that those patients with right-sided disease involving the tricus‐ pid valve might warrant a change in how their disease has been traditionally managed. Historically, tricuspid disease has rarely been viewed as a surgical problem and most pa‐ tients who underwent prolonged medical treatments — and often as a function of the base‐ line comorbidities (i.e., IVDA) or untreated, or undertreated, right-sided heart failure or pulmonary septic complication‑did very poorly. As such, with greater recognition of the catastrophic complications associated with right-sided disease, there has been growing inter‐ est in better defining the guidelines for both medical and surgical management. In addition, as more patients, with more comorbidities, who are older, sicker, frailer, are offered surgical or catheter-based therapies for their structural heart disease, combined with better diagnostic

tools, the incidence and sheer number of endocarditis cases are increasing rapidly.

The challenges in the diagnosis and medical and surgical management of patients with en‐ docarditis clearly illustrate the value of developing and engaging a multidisciplinary team. Such a team of dedicated providers, as with many areas of cardiovascular case, help navi‐ gate a patient through a very difficult, and often unpredictable, disease course. Effective and efficient team communication is critical and can often be the definitive factor in achieving clinical success. The topic of "endocarditis" in itself can be overwhelming and, almost by definition, a singular book would quickly become both out of date and incomplete. It is hence the goal of this book, as a continuation of the previous volume on this topic, to high‐ light some of the current controversies and difficulties in this extremely complex topic.

As the Editor of this book, I want to extend my deepest appreciation to not only those who contributed to this volume, but also to the countless providers who care for, what are often, very sick, complex, and difficult patients. In addition, most importantly, I want to thank my family and close friends who supported me during the countless hours needed not only to manage these patients but also to share my interests in educating, mentoring, and support‐

**Michael S. Firstenberg, MD FACC**

Northeast Ohio Medical University

Northeast Ohio Medical University

The Medical Center of Aurora Aurora, Colorado, USA

Adjunct Associate Professor of Surgery and Integrative Medicine

The Department Cardiothoracic and Cardiovascular Surgery

Adjunct Graduate Faculty College of Graduate Studies

ing those who contributed to this text.

VIII Preface

**Chapter 1**

Provisional chapter

**Introductory Chapter: Introduction to Advanced**

DOI: 10.5772/intechopen.79883

Infective endocarditis is a broad topic that encompasses various types of infections of the heart and is typically used to describe abscess cavities, infectious or inflammatory vegetations on cardiac structures such as valves or implanted prosthetic devices, fistulae, or areas of localized infectious tissue destruction. Without a doubt, infectious problems involving the heart or cardiac structures represent a formidable diagnostic and therapeutic clinical problem. Furthermore, despite advances in medical and surgical therapies—some of which are highlighted in this text there are concerns that there are significant increases in the number of cases reported. Even more concerning are some of the issues that have resulted in the increased incidence of endocarditis case and what impact these issues might have on how individual patients are managed and how society approaches this complex (and expensive) medical, surgical, and—now—social problem. It is also becoming more apparent that even relatively minor procedures are associated with a risk of infecting both native and prosthetic cardiac structures [1]. Historically, it was assumed that procedures, such as dental work, had a significant role in the development of endocarditis and other procedures, such as endoscopic evaluations, had a minimal role, and therefore prophylactic antibiotics before all such "minor" procedures were not necessary. However, recent evidence suggests that there is a much greater risk for post-procedure endocarditis than initially thought—especially those with inherently abnormal cardiac structures, such as mitral

The epidemiology of infections reflects not only the dark side of the progresses in medical therapy but also some of the social problems that plague modern society. The changing microbiology also reflects how this complex disease has also paralleled the advances in medicine. Diagnostic tools continue to evolve with not only improvements in imaging technologies but also our understandings on how to appropriately use them to better understand the overall clinical picture. In addition, the role of therapies—especially early surgical intervention—has

> © 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited.

© 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Introductory Chapter: Introduction to Advanced

**Concepts in Endocarditis**

Concepts in Endocarditis

http://dx.doi.org/10.5772/intechopen.79883

valve prolapse or bicuspid aortic valves [2].

Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

Michael S. Firstenberg

Michael S. Firstenberg

1. Introduction

#### **Introductory Chapter: Introduction to Advanced Concepts in Endocarditis** Introductory Chapter: Introduction to Advanced Concepts in Endocarditis

DOI: 10.5772/intechopen.79883

Michael S. Firstenberg Michael S. Firstenberg

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.79883
