title: The importance of preoperative magnetic resonance imaging in valve surgery for active infective endocarditis.
abstract: OBJECTIVE
  Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T(2)*- weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes.
  
  
  METHODS
  Eighteen patients were referred to our department for native valve IE during 2006-2010. Urgent surgery was indicated in cases of hemodynamic failure resulting from valve destruction, refractory sepsis, and mobile vegetations measuring >10 mm. For these patients, we performed preoperative MRI and MRA.
  
  
  RESULTS
  Males comprised 67% of the subjects, with average age 53 ± 15 years. No clinical evidence of acute stroke was noted. Of the 18 patients, urgent surgery was indicated in 15; of these, 10 (67%) showed a brain lesion related to IE: 6 patients had acute or subacute brain infarctions, 2 patients had brain infarction with brain abscess, and 2 patients had hemorrhagic brain infarction and so did not undergo urgent surgery. Thus, 13 patients underwent urgent valve surgery. Among the 5 patients who did not undergo urgent surgery, 4 patients later underwent valve surgery for healed IE. No hospital deaths or neurological complications occurred.
  
  
  CONCLUSIONS
  MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes.
authors.affiliation: Department of Cardiovascular Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutukake-cho, Toyoake, Aichi 470-1192, Japan. ytakagi@fujita-hu.ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Higuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kondo
authors.forename: Kiyotoshi
authors.initials: K
authors.lastname: Akita
authors.forename: Michiko
authors.initials: M
authors.lastname: Ishida
authors.forename: Kan
authors.initials: K
authors.lastname: Kaneko
authors.forename: Ryo
authors.initials: R
authors.lastname: Hoshino
authors.forename: Masato
authors.initials: M
authors.lastname: Sato
authors.forename: Motomi
authors.initials: M
authors.lastname: Ando
mesh_terms: D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002533:Cerebral Angiography / Q000379:methods*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000209:etiology; D038524:Diffusion Magnetic Resonance Imaging; D004696:Endocarditis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis* / Q000209:etiology; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000209:etiology; D007564:Japan; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D016896:Treatment Outcome