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Management of infectious endocarditis with mycotic aneurysm evaluated by brain magnetic resonance imaging.
- Source :
-
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2013 Nov; Vol. 44 (5), pp. 924-30. Date of Electronic Publication: 2013 Mar 08. - Publication Year :
- 2013
-
Abstract
- 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.<br />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.<br />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.<br />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.
- Subjects :
- Adult
Aneurysm, Infected microbiology
Brain pathology
Cardiac Surgical Procedures adverse effects
Female
Humans
Male
Middle Aged
Postoperative Complications etiology
Postoperative Complications microbiology
Retrospective Studies
Aneurysm, Infected diagnosis
Aneurysm, Infected therapy
Cardiac Surgical Procedures methods
Endocarditis, Bacterial complications
Endocarditis, Bacterial therapy
Magnetic Resonance Imaging methods
Subjects
Details
- Language :
- English
- ISSN :
- 1873-734X
- Volume :
- 44
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23475590
- Full Text :
- https://doi.org/10.1093/ejcts/ezt101