Preface

Despite advances in medical and surgical treatments, infective endocarditis continues to be an important clinical problem. It has an in-hospital mortality of 10-20%, and many patients will require valve surgery during long-term follow-up. The diagnosis is difficult since it is based on a constellation of findings and none of the clinical findings alone is pathognomonic. Unequivocal diagnosis is often made only at surgery or autopsy.

Our aim is to provide an up-to-date approach to the diagnosis and management of endocarditis based on a critical analysis of recent studies. The book is structured in a format that is easy to follow, clinically relevant, and evidence-based. Key points are listed at the end of each chapter for quick review. It is divided into three sections. The first section provides a comprehensive review of the basic principles underlying the management of endocarditis. In addition to chapters on etiologic agents and pathologic findings, the changing epidemiology and the vexing issue of antibiotic prophylaxis are discussed. The second section presents the clinical principles underlying the diagnosis and treatment approaches, both medical and surgical. The role of transthoracic and transesophageal echocardiography is discussed in detail, particularly in relation to false-positive and false-negative test results. The third section focuses on difficult clinical scenarios frequently encountered in patients with this disease, including culture-negative endocarditis, prosthetic valve endocarditis, natural history and management of perivalvular abscess, systemic embolism, and etiologies and treatments of neurologic events. The practical clinical approach of this section is underscored by the inclusion of an illustrative case in each of the clinical chapters in the book.

We sincerely hope that this book will serve as an important source of clinical information on diagnosis and management of endocarditis that is useful to all practitioners involved in the care of these critically ill patients.

We would like to thank all the authors for their thoughtful and erudite contributions covering the protean facets of this challenging disease. We are indebted to our colleagues, past and present, for their support and inspiration. Finally, we would like to express our sincere appreciation to our families for their understanding, patience and encouragement without which this text would not have become a reality.

Kwan-Leung Chan John M. Embil

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