[Clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms].
OBJECTIVE
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
Sanz
O
O
ICICOR, Hospital Universitario, Servicio de Cardiologia, Ramón y Cajal, 3, 47011 Valladolid, Spain.
San Román
J A
JA
Vilacosta
I
I
Graupner
C
C
Sarriá
C
C
Vega
J L
JL
Fernández-Avilés
F
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging* / Q000628:therapy; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies