IE (infective endocarditis) occurs when germs (especially bacteria but occasionally fungi and other microbes) enter the blood stream and stick to lining of heart valves. These growths produce toxins and enzymes that destroy tissue and create holes on the valves. The invasion also extends outside the heart and circulates through the body, making it more difficult to cure with antibiotics alone.
Endocarditis infection can cause:
- Pieces of tissue the growths to break off and travel in the blood stream (embolism) causing a stroke
- The valve tissue to be destroyed causing a leaky heart valve and heart failure
- Abscesses around the heart valve.
Without treatment, IE is a fatal disease. Early evaluation and treatment is essential.
Once valve damage has occurred this does not heal even if the infection is cured with antibiotics. A team of medical exerts including an infectious disease specialist, a cardiologist, and a cardiac surgeon is required to make sure the correct diagnosis is made, appropriate antibiotic treatment has been prescribed, and to decide if and when surgery is beneficial or necessary. In addition, a neurologist should be involved to evaluate neurological complications.
To allow fastest possible diagnosis and treatment to prevent the serious consequences of endocarditis, the Cleveland Clinic’s Endocarditis Center provides comprehensive urgent care to treat acute episodes of endocarditis; manage endocarditis non-responsive to medical therapies; and long term care to prevent endocarditis from occurring in the future.
What We Treat
Patients come to Cleveland Clinic for endocarditis care in a variety of settings:
- Urgent transfer from outside hospital for an acute episode of endocarditis
- Need for surgery to treat valve disease caused by endocarditis
- Need for surgery to treat an infected replacement valve (prosthetic valve endocarditis)
- Symptoms of recent fever, illness, stroke or other embolic manifestation suggestive of endocarditis
- Endocarditis not responsive to antibiotic treatment
- Complications of prior bouts of endocarditis requiring additional medical or surgical treatment
In addition, the Endocarditis Center team treats other types of heart infections such as those associated with devices (pacemakers, leads, LVADs) and aortic grafts.
Our Medical and Surgical Team
The Cleveland Clinic Endocarditis Center offers a multi-disciplinary team of specialists in infectious disease, cardiology, cardiothoracic surgery, neurology, and psychology.
- Gosta Pettersson, MD, PhD Director
- Patrick Collier, MD
- Paul Cremer, MD
- Brian Griffin, MD
- Richard Grimm DO
- Wael Jaber, MD
- Christine Jellis, MD
- Dermot Phelan, MD
- Leonardo Rodriguez, MD
- Maran Thamilarasan, MD
- Faisal Bakaeen, MD
- Douglas Johnston, MD
- Kenneth McCurry, MD
- José Navia, MD
- Gosta Pettersson, MD, PhD
- Eric Roselli, MD
- Nicholas Smedira, MD
- Edward Soltesz, MD
- Per Wierup, MD, PhD
Behavioral Health: Addiction Medicine
Most patients with endocarditis may come in through physician referral or are hospitalized elsewhere but need surgery or care at a specialized center:
- Physician Referrals - Call 800.659.7822 (or call physicians’ office directly).
- Patient Transfers - Call Patient Access Services locally at 216.444.8302 or toll-free 800.553.5056.
This is a direct-access, 24-hour phone line for physicians with patients who need to be admitted to our facility.
If you are a patient and would like to make an appointment or need advise what to do:
- If you think you have active Endocarditis: You need to go to the emergency room (ER). If you live in the Cleveland area this can be any of the ERs run by the Cleveland Clinic. If the suspicion is confirmed you will be admitted either to one of our local hospitals or sent to the Cleveland Clinic main campus. It is of outmost importance that the diagnosis is made early and that the causing organism is identified to prevent complications!
- Cardiology Appointments: Valve Endocarditis Specialists: Please call toll-free 800.659.7822 Cardiology Appointments or Request an Appointment online.
- Cardiothoracic Surgery Appointments: If you would like information about your surgical options for your valve disease, contact the Heart and Vascular Institute Resource Nurses, who will provide you with information on the process for surgical review – please let us know if this is an urgent matter.
No referral is necessary unless your insurance requires you to have one.
Cardiology Appointments: Valve Endocarditis Specialists:
Before your appointment:
If you are scheduled at least one week away, you will be asked to send in your records, including medical history, test results and films (such as echocardiogram, chest x-ray, MRI or CT as applicable). All information should be sent in the same package (clearly marked with your name and address) via Airborne Express, Federal Express, or certified U.S. mail (make sure you have a tracking number) to the physician with which you have an appointment. The address is:
9500 Euclid Avenue – Desk J1-5
Cleveland, OH 44195
If you are scheduled less than one week out, please bring your records to your appointment.
What to expect during your appointment
You will meet with a nurse who will collect your information, and begin the documentation process.
Testing will be tailored to your prior medical history, presenting complaint and findings at the time of your evaluation. Tests may include blood tests, electrocardiogram, echocardiogram, chest x-ray, and other imaging studies as needed.
You will meet with a cardiologist who will review your records and medical history, do a physical examination review your testing and provide you with an assessment and plan.
You will also meet with an Infectious Disease specialist who will review your medical management
If you need to meet with one of the other multi-disciplinary specialists, they will be consulted in 1-2 days
How long will you need to stay at Cleveland Clinic?
To complete all testing, you will need to stay in the Cleveland area for 1 to 2 days. Additional stay will be based on plan of treatment.
Most follow-up will be done in 6 months to 1 year or as needed. There is an opportunity for telephone follow-up as well
Traveling to Cleveland Clinic
When you make your appointment, we would like to make traveling to Cleveland Clinic as easy as possible.
Publications & Research
Current Cleveland Clinic Endocarditis Publications
- Infective endocarditis: an atlas of disease progression for describing, staging, coding, and understanding the pathology. Pettersson GB, Hussain ST, Shrestha NK, Gordon S, Fraser TG, Ibrahim KS, Blackstone EH. J Thorac Cardiovasc Surg. 2014 Apr;147(4):1142-1149.e2. doi: 10.1016/j.jtcvs.2013.11.031. Epub 2013 Dec 14. Review. No abstract available.
- Residual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis. Hussain ST, Shrestha NK, Gordon SM, Houghtaling PL, Blackstone EH, Pettersson GB. J Thorac Cardiovasc Surg. 2014 Sep;148(3):981-8.e4. doi: 10.1016/j.jtcvs.2014.06.019. Epub 2014 Jun 13.
- Reconstruction of fibrous skeleton: technique, pitfalls and results. Pettersson GB, Hussain ST, Ramankutty RM, Lytle BW, Blackstone EH. Multimed Man Cardiothorac Surg. 2014 Jun 18;2014. pii: mmu004. doi: 10.1093/mmcts/mmu004. Print 2014.
- Outcomes after surgical treatment of native and prosthetic valve infective endocarditis. Manne MB, Shrestha NK, Lytle BW, Nowicki ER, Blackstone E, Gordon SM, Pettersson G, Fraser TG. Ann Thorac Surg. 2012 Feb;93(2):489-93. doi: 10.1016/j.athoracsur.2011.10.063. Epub 2011 Dec 28.
- (Early surgery versus conventional treatment for infective endocarditis. Kang DH, Kim YJ, Kim SH, Sun BJ, Kim DH, Yun SC, Song JM, Choo SJ, Chung CH, Song JK, Lee JW, Sohn DW. N Engl J Med. 2012 Jun 28;366(26):2466-73. doi: 10.1056/NEJMoa1112843. PMID:22738096) Editorial: Native-Valve Infective Endocarditis — When Does It Require Surgery? Steven M. Gordon, M.D., and Gösta B. Pettersson, M.D., Ph.D. N Engl J Med 2012; 366:2519-2521DOI: 10.1056/NEJMe1205453
- Injection Drug Use and Outcomes After Surgical Intervention for Infective Endocarditis. Shrestha NK, Jue J, Hussain ST, Jerry JM, Pettersson GB, Menon V, Navia JL, Nowacki AS, Gordon SM. Ann Thorac Surg. 2015 Jun 19. pii: S0003-4975(15)00400-2. doi: 10.1016/j.athoracsur.2015.03.019. [Epub ahead of print]
- Infective endocarditis after transcatheter aortic valve implantation: results from a large multicenter registry. Amat-Santos IJ, Messika-Zeitoun D, Eltchaninoff H, Kapadia S, Lerakis S, Cheema AN, Gutiérrez-Ibanes E, Munoz-Garcia AJ, Pan M, Webb JG, Herrmann HC, Kodali S, Nombela-Franco L, Tamburino C, Jilaihawi H, Masson JB, de Brito FS Jr, Ferreira MC, Lima VC, Mangione JA, Iung B, Vahanian A, Durand E, Tuzcu EM, Hayek SS, Angulo-Llanos R, Gómez-Doblas JJ, Castillo JC, Dvir D, Leon MB, Garcia E, Cobiella J, Vilacosta I, Barbanti M, R Makkar R, Ribeiro HB, Urena M, Dumont E, Pibarot P, Lopez J, Roman AS, Rodés-Cabau J. Circulation. 2015 May 5;131(18):1566-74. doi: 10.1161/CIRCULATIONAHA.114.014089. Epub 2015 Mar 9.
- Heart valve culture and sequencing to identify the infective endocarditis pathogen in surgically treated patients. Shrestha NK, Ledtke CS, Wang H, Fraser TG, Rehm SJ, Hussain ST, Pettersson GB, Blackstone EH, Gordon SM. Ann Thorac Surg. 2015 Jan;99(1):33-7. doi: 10.1016/j.athoracsur.2014.07.028. Epub 2014 Oct 22.
- The ultimate development of mitral valve endocarditis: atrioventricular separation, atrioventricular groove abscess and hemorrhagic pericarditis. Atik FA, Pettersson GB, Sigurdsson G, Gonzalez-Stawinski GV, Sabik EM, Kim A, Svensson LG. J Heart Valve Dis. 2005 Jan;14(1):29-32.
- Aortic root replacement with cryopreserved allograft for prosthetic valve endocarditis. Sabik JF, Lytle BW, Blackstone EH, Marullo AG, Pettersson GB, Cosgrove DM. Ann Thorac Surg. 2002 Sep;74(3):650-9; discussion 659.
- Reoperative cryopreserved root and ascending aorta replacement for acute aortic prosthetic valve endocarditis. Lytle BW, Sabik JF, Blackstone EH, Svensson LG, Pettersson GB, Cosgrove DM 3rd. Ann Thorac Surg. 2002 Nov;74(5):S1754-7; discussion S1792-9.
- Clinical utility of cerebral angiography in the preoperative assessment of endocarditis. Monteleone PP, Shrestha NK, Jacob J, Gordon SM, Fraser TG, Rehm SJ, Bajzer CT, Kapadia SR, Pettersson GB, Lytle BW, Blackstone EH, Shishehbor MH. Vasc Med. 2014 Dec;19(6):500-6. doi: 10.1177/1358863X14557152. Epub 2014 Oct 31.
- Successful surgical treatment of rare Aspergillus terreus prosthetic valve endocarditis complicated by intracranial and mesenteric artery mycotic aneurysms. Ahmad RA, Hussain ST, Tan CD, Pettersson GB, Clair D, Gordon SM. J Thorac Cardiovasc Surg. 2014 Nov;148(5):e221-3. doi: 10.1016/j.jtcvs.2014.06.084. Epub 2014 Jul 22. No abstract available.
- Successful allograft root re-replacement for prosthetic valve endocarditis with improvement of renal function in a Jehovah's Witness patient. Hussain ST, Blackstone EH, Pettersson GB. J Thorac Cardiovasc Surg. 2014 Oct;148(4):e199-200. doi: 10.1016/j.jtcvs.2014.06.066. Epub 2014 Jul 21. No abstract available.
- Intracardiac abscess with cutaneous fistula secondary to ventricular septal defect repair simulating sternal wound infection. Rafael AE, Keshavamurthy S, Sepulveda E, Miranda CC, Okamoto T, Pettersson GB. Tex Heart Inst J. 2014 Jun 1;41(3):324-6. doi: 10.14503/THIJ-13-3199. eCollection 2014 Jun.
- Mycotic aneurysm detection rates with cerebral angiography in patients with infective endocarditis. Hui FK, Bain M, Obuchowski NA, Gordon S, Spiotta AM, Moskowitz S, Toth G, Hussain S. J Neurointerv Surg. 2015 Jun;7(6):449-52. doi: 10.1136/neurintsurg-2014-011124. Epub 2014 Apr 28.
- Outcomes after endocarditis or device infection in patients with left ventricular epicardial leads versus coronary sinus leads. Karim S, Hussein A, Batal O, Karim MM, Tarakji K, Saliba W, Martin D, Wazni O, Kanj M, Wilkoff BL, Callahan T. J Interv Card Electrophysiol. 2014 Apr;39(3):267-71. doi: 10.1007/s10840-014-9880-4. Epub 2014 Feb 23.
- Staphylococcus lugdunensis: a rare but destructive cause of coagulase-negative staphylococcus infective endocarditis. Sabe MA, Shrestha NK, Gordon S, Menon V. Eur Heart J Acute Cardiovasc Care. 2014 Sep;3(3):275-80. doi: 10.1177/2048872614523350. Epub 2014 Feb 12.
- The clinical picture: fever, dyspnea, and a new heart murmur. Jackson G, Camargo C, Ling LF, Kalahasti V, Rimmerman CM. Cleve Clin J Med. 2013 Sep;80(9):559-61. doi: 10.3949/ccjm.80a.12049. No abstract available.
- Mycoplasma hominis prosthetic valve endocarditis: the value of molecular sequencing in cardiac surgery. Hussain ST, Gordon SM, Tan CD, Smedira NG. J Thorac Cardiovasc Surg. 2013 Jul;146(1):e7-9. doi: 10.1016/j.jtcvs.2013.03.039. Epub 2013 May 1. No abstract available.
- Contemporary drug treatment of infective endocarditis. Sabe MA, Shrestha NK, Menon V. Am J Cardiovasc Drugs. 2013 Aug;13(4):251-8. doi: 10.1007/s40256-013-0015-6.
- Endovascular infections caused by Histoplasma capsulatum: a case series and review of the literature. Ledtke C, Rehm SJ, Fraser TG, Shrestha NK, Tan CD, Rodriguez ER, Tomford JW, Jain A, Lytle B, Johnston D, Sabik J, Gordon SM, van Duin D. Arch Pathol Lab Med. 2012 Jun;136(6):640-5. doi: 10.5858/arpa.2011-0050-OA. Review.
- Staphylococcus aureus endocarditis complicated by aortic root abscess, coronary fistula, and mitral valve perforation. Ling LF, To AC, Menon V. J Am Coll Cardiol. 2012 Apr 17;59(16):e31. doi: 10.1016/j.jacc.2011.06.086. No abstract available.
- Surgical treatment of endocarditis: current status. Pettersson GB. Tex Heart Inst J. 2011;38(6):667-8. No abstract available.
- Surgical treatment of prosthetic valve endocarditis. Lytle BW, Priest BP, Taylor PC, Loop FD, Sapp SK, Stewart RW, McCarthy PM, Muehrcke D, Cosgrove DM 3rd. J Thorac Cardiovasc Surg. 1996 Jan;111(1):198-207; discussion 207-10.
- The incorporated aortomitral homograft: a new surgical option for double valve endocarditis. Navia JL, Al-Ruzzeh S, Gordon S, Fraser T, Agüero O, Rodríguez L. J Thorac Cardiovasc Surg. 2010 Apr;139(4):1077-81. doi: 10.1016/j.jtcvs.2009.05.017. No abstract available.
- Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997. Gordon SM, Serkey JM, Longworth DL, Lytle BW, Cosgrove DM 3rd. Ann Thorac Surg. 2000 May;69(5):1388-92.
- Aortic allograft valve reoperation: surgical challenges and patient risks. Nowicki ER, Pettersson GB, Smedira NG, Roselli EE, Blackstone EH, Lytle BW. Ann Thorac Surg. 2008 Sep;86(3):761-768.e2. doi: 10.1016/j.athoracsur.2008.01.102.
- Staphylococcus aureus: the new adventures of a legendary pathogen. Rehm SJ. Cleve Clin J Med. 2008 Mar;75(3):177-80, 183-6, 190-2. Review.
- Infective endocarditis prophylaxis before dental procedures: new guidelines spark controversy. Kim A, Keys T. Cleve Clin J Med. 2008 Feb;75(2):89-92. Review. No abstract available. Erratum in: Cleve Clin J Med. 2008 Apr;75(4):318. Dosage error in article text.
- Invited commentary. It would not be wise to completely abandon the use of homograft root replacement in particular in patients with prosthetic valve endocarditis and aortic root abscess. Mihaljevic T. Ann Thorac Surg. 2007 Dec;84(6):1942. No abstract available.
- Deep sternal wire infection resulting in severe pulmonary valve endocarditis. Bhavani SS, Slisatkorn W, Rehm SJ, Pettersson GB. Ann Thorac Surg. 2006 Sep;82(3):1111-3.
- Role of Echocardiography in Diagnosis and Management of Endocarditis. Murphy RT, Garcia MJ. Curr Infect Dis Rep. 2005 Jul;7(4):257-263.
- Endocarditis after mitral valve repair. Gillinov AM, Faber CN, Sabik JF, Pettersson G, Griffin BP, Gordon SM, Hayek E, Di Paola LM, Cosgrove DM 3rd, Blackstone EH. Ann Thorac Surg. 2002 Jun;73(6):1813-6.
- Caring for patients with prosthetic heart valves. Bettadapur MS, Griffin BP, Asher CR. Cleve Clin J Med. 2002 Jan;69(1):75-87. Review.
- Double valve endocarditis. Gillinov AM, Diaz R, Blackstone EH, Pettersson GB, Sabik JF, Lytle BW, Cosgrove DM 3rd. Ann Thorac Surg. 2001 Jun;71(6):1874-9.
- Cardiac valve replacement in patients on dialysis: influence of prosthesis on survival. Kaplon RJ, Cosgrove DM 3rd, Gillinov AM, Lytle BW, Blackstone EH, Smedira NG. Ann Thorac Surg. 2000 Aug;70(2):438-41.
- Incidence and risk of developing fungal prosthetic valve endocarditis after nosocomial candidemia. Nasser RM, Melgar GR, Longworth DL, Gordon SM. Am J Med. 1997 Jul;103(1):25-32.
- Is there an advantage to repairing infected mitral valves? Muehrcke DD, Cosgrove DM 3rd, Lytle BW, Taylor PC, Burgar AM, Durnwald CP, Loop FD. Ann Thorac Surg. 1997 Jun;63(6):1718-24.
- Fungal prosthetic valve endocarditis in 16 patients. An 11-year experience in a tertiary care hospital. Melgar GR, Nasser RM, Gordon SM, Lytle BW, Keys TF, Longworth DL. Medicine (Baltimore). 1997 Mar;76(2):94-103.
- Surgical and long-term antifungal therapy for fungal prosthetic valve endocarditis. Muehrcke DD, Lytle BW, Cosgrove DM 3rd. Ann Thorac Surg. 1995 Sep;60(3):538-43.
- Surgical treatment of prosthetic valve endocarditis. Lytle BW. Semin Thorac Cardiovasc Surg. 1995 Jan;7(1):13-9. Review.
As illustrated by the reference list we have a longstanding interest in treatment of patients with endocarditis. We have a registry of all these patients treated for endocarditis at the Cleveland Clinic. All cases are carefully reviewed by a specialist to make sure each case is characterized correctly by diagnosis, causing organism, complications and surgical pathology. This registry has already provided new information about the progression of the disease and its complications and surgical management.