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Published on: June 20, 2014
Management of infectious endocarditis with mycotic aneurysm evaluated by brain magnetic resonance imaging
Hajime Kin1, Kunihiro Yoshioka, Kohei Kawazoe
1Department of Cardiovascular Surgery, Memorial Heart Center, Iwate Medical University, Iwate, Japan.
Objectives:
Cerebral complications of infective endocarditis (IE) [particularly, mycotic aneurysm, visualized as a hypointense spot on T2*-weighted brain magnetic resonance imaging (MRI)] are associated with a high incidence of postoperative cerebral or subarachnoid hemorrhage. We have adopted a policy of performing elective open heart surgery after performing a MRI enhanced by gadolinium in such patients whenever possible after improvement in inflammatory findings around a cerebral aneurysm.
Methods:
Fifty-six patients (35 men and 21 women, mean age 56 years) diagnosed with active-phase IE between January 2000 and December 2010 were analysed retrospectively.
Results:
Six patients who had not undergone MRI were excluded. The remaining patients were classified into four groups according to preoperative brain MRI findings-Group A (n = 13): cerebral haemorrhage, cerebral infarction, abscess and encephalitis; Group B (n = 7): simple or multiple black dots ( = hypointensive spots) with cerebral haemorrhage or cerebral infarction; Group C (n = 15): simple or multiple black dots alone; Group D (n = 15): no abnormal MRI findings. None of the 12 patients who successfully underwent elective surgery in Groups B and C developed postoperative cerebral complications.
Conclusions:
Brain MRI is an important tool for the detection of asymptomatic intracranial abnormalities associated with IE and evaluation of the preoperative bleeding risk of patients. Patients with contrast enhancement around black dots are at high risk for bleeding, and performing open heart surgery in such patients whenever possible after the improvement of inflammatory findings reduces the potential risk of cerebral haemorrhage.
Insights
Brain MRI aids in detecting asymptomatic intracranial issues in infective endocarditis (IE). Performing surgery after inflammatory improvement in high-risk patients reduces bleeding complications.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebral complications, such as mycotic aneurysms, are common in infective endocarditis (IE).
- These complications, often seen as hypointense spots on T2*-weighted MRI, increase the risk of postoperative hemorrhage.
Purpose of the Study:
- To evaluate the utility of preoperative brain MRI in assessing bleeding risk in IE patients.
- To determine the optimal timing for open-heart surgery in relation to MRI findings and inflammatory status.
Main Methods:
- Retrospective analysis of 56 patients with active-phase IE between 2000-2010.
- Patients were categorized into four groups based on preoperative brain MRI findings (hemorrhage, infarction, abscess, encephalitis, or hypointense spots).
- Comparison of postoperative cerebral complications in patients who underwent elective surgery versus those who did not.
Main Results:
- 13 patients had cerebral hemorrhages, infarctions, abscesses, or encephalitis (Group A).
- 7 patients had hypointense spots with cerebral hemorrhages or infarctions (Group B).
- 15 patients had isolated hypointense spots (Group C), and 15 had normal MRI findings (Group D).
- None of the 12 patients in Groups B and C who underwent elective surgery developed postoperative cerebral complications.
Conclusions:
- Brain MRI is crucial for detecting asymptomatic intracranial abnormalities in IE patients.
- Patients with contrast enhancement around "black dots" (hypointense spots) face a high bleeding risk.
- Elective surgery after inflammatory improvement in these patients can mitigate the risk of cerebral hemorrhage.
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