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Perivalvular pseudoaneurysm complicating bacterial endocarditis: MR detection in five cases
E W Akins1, R M Slone, B N Wiechmann
1Department of Radiology, University of Florida College of Medicine, JHMHC, Gainesville 32610-0374.
Abstract:
Bacterial endocarditis usually affects the valve leaflets, but erosion into the valve anulus and adjacent myocardium may form a myocardial abscess. Perivalvular abscesses can drain into the ventricles or aorta, forming a life-threatening pseudoaneurysm. We reviewed our experience with cardiac MR imaging of this disorder. Fourteen patients with complicated bacterial endocarditis underwent ECG-gated spin-echo cardiac MR imaging in addition to conventional duplex two-dimensional echocardiography (2-D echo). Angiography was performed in seven patients, six of whom underwent surgery for valve replacement. MR imaging detected the pseudoaneurysms in all five of the surgically proved cases, while 2-D echo detected only three. Clinical follow-up suggested there were no false-negative examinations, but no autopsy data were available for confirmation. Postoperative MR imaging studies were conducted in three patients, revealing two recurrent pseudoaneurysms and one thrombosed aneurysm. Cardiac MR imaging provides useful pre- and postoperative information in patients with perivalvular pseudoaneurysms due to endocarditis.
Insights
Cardiac MR imaging effectively detects life-threatening perivalvular pseudoaneurysms in bacterial endocarditis patients. This advanced imaging offers crucial pre- and postoperative insights, surpassing traditional echocardiography in identifying these complications.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- Bacterial endocarditis typically impacts heart valve leaflets.
- Erosion can lead to myocardial abscesses and perivalvular abscesses.
- These abscesses may rupture, forming pseudoaneurysms, a critical complication.
Purpose of the Study:
- To evaluate the efficacy of cardiac Magnetic Resonance (MR) imaging in diagnosing perivalvular pseudoaneurysms secondary to bacterial endocarditis.
- To compare the diagnostic performance of cardiac MR imaging with conventional echocardiography.
Main Methods:
- Retrospective review of 14 patients with complicated bacterial endocarditis.
- ECG-gated spin-echo cardiac MR imaging was performed.
- Comparison with duplex two-dimensional echocardiography (2-D echo) and angiography where available.
Main Results:
- Cardiac MR imaging detected pseudoaneurysms in all 5 surgically confirmed cases.
- 2-D echocardiography identified only 3 of these pseudoaneurysms.
- Postoperative MR imaging identified recurrent pseudoaneurysms and thrombosed aneurysms.
Conclusions:
- Cardiac MR imaging is a valuable tool for diagnosing perivalvular pseudoaneurysms in endocarditis.
- It provides essential pre- and postoperative information, aiding clinical management.
- MR imaging demonstrates superior sensitivity compared to 2-D echocardiography for these specific complications.