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[Clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms]
O Sanz1, J A San Román, I Vilacosta
1ICICOR, Hospital Universitario, Servicio de Cardiologia, Ramón y Cajal, 3, 47011 Valladolid, Spain.
Insights
Endocarditis with periannular pseudoaneurysms indicates high mortality, often aortic. Medical treatment is viable for select patients without other surgical needs, showing stable pseudoaneurysm size over time.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Periannular pseudoaneurysms in endocarditis are poorly understood.
- Pseudoaneurysm presence is often incorrectly cited as a surgical indication.
Purpose of the Study:
- To define the clinical profile and prognosis of endocarditis patients with periannular pseudoaneurysms.
- To evaluate the role of medical versus surgical management.
Main Methods:
- Followed 18 patients with endocarditis and pseudoaneurysm.
- Diagnosis confirmed by transesophageal echocardiography and/or surgery.
- Mean follow-up of 14 months.
Main Results:
- Aortic pseudoaneurysms were most common (n=14), often around prosthetic valves.
- Staphylococci and streptococci were frequent pathogens.
- Surgery had a 45% mortality rate; medical treatment had a 28% mortality rate.
- Pseudoaneurysm size remained stable in asymptomatic medically treated patients.
Conclusions:
- Periannular pseudoaneurysms identify endocarditis patients with high mortality risk.
- Medical management is a reasonable option when no other surgical indications exist.
- Pseudoaneurysm size does not progress in medically managed patients.
Introduction And Objectives:
Little information is available on the clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms because the presence of pseudoaneurysm itself is considered an indication albeit not an evidence-based indication, for surgery.
Methods:
We followed 18 patients (11 males, mean age: 5 +/- 4) with endocarditis and pseudoaneurysm diagnosed by transesophageal echocardiography and/or at surgery over 14 +/- 5 months.
Results:
Aortic (n = 14; 6 on native valve, 8 on prosthesis) was more frequent than mitral (n = 3; 3 prosthesis) or tricuspid location (n = 1). Auriculoventricular block developed in 6 patients, all with aortic pseudoaneurysm. The most frequently involved microorganisms were staphylococci (n = 5) and streptococci (n = 5). Abscesses were found in 5 patients. Pseudoaneurysm was not considered an indication for surgery. Eleven patients underwent surgery 5 died after surgery (45%), 1 had reinfection and 5 are asymptomatic. The remaining 7 patients received only medical treatment: two died (28%), one developed reinfection and 4 are asymptomatic. The size of the pseudoaneurysm remained stable after 24 months of follow-up in the 4 asymptomatic medically treated patients (maximal diameter: 21 +/- 5 at diagnosis versus 22 +/- 5 at latest follow-up; p = NS).
Conclusions:
We conclude that the presence of a pseudoaneurysm identifies a subset of endocarditis patients with a high mortality. Pseudoaneurysms are usually located in an aortic position and around prosthetic material. Medical treatment without surgery should be considered when no other surgical indications exist. Lastly the size of a pseudoaneurysm in medically treated patients does not increase over time