Valvular Heart Disease
Clinical course, microbiologic profile, and diagnosis of periannular complications in prosthetic valve endocarditis

https://doi.org/10.1016/S0002-9149(99)00018-1Get rights and content

Abstract

Whether periannular extension of prosthetic valve endocarditis (abscesses, pseudoaneurysms, fistulas) is related to the etiologic agent, the clinical course and the prognosis is still unknown. Likewise, transesophageal echocardiographic accuracy in detecting periannular complications in prosthetic recipients remains unsettled. We retrospectively analyzed data from 87 patients with anatomically proven prosthetic valve endocarditis who underwent a transesophageal echocardiographic examination. Periannular complications (30 abscesses, 18 pseudoaneurysms, 8 fistulas; 8 with >1) were found in 46 patients; results were compared with the remaining 41 without complications. Transesophageal echocardiography correctly identified 27 abscesses (90%) and all pseudoaneurysms and fistulas. One diagnosis of pseudoaneurysm by echocardiography was not found at surgery. No statistical differences were found regarding age, sex, type of prosthesis (mechanical vs biologic), and etiologic agent. Periannular complications were more frequent in aortic location (70% vs 20% in mitral position; p <0.001) and in early (within 6 months after surgery) endocarditis (63% vs 38% in late endocarditis; p = 0.04). The same percentage of patients from both groups underwent surgery (98% with and 90% without complications). At discharge, 62% and 67% of patients were alive, respectively. Thus, periannular complications in prosthetic valve endocarditis are more frequent in aortic location and within 6 months after surgery. Neither the type of prosthesis nor the etiologic agent are related to the presence of periannular complications. Short-term prognosis in patients who underwent surgery is not affected by the presence of periannular complications.

Section snippets

Study population

The medical records of 87 consecutive patients with PVE were retrospectively reviewed. To enter the study, patients had to meet the following criteria: (1) prosthesis in the mitral or aortic position; (2) definite von Reyn criteria12 (thus, surgery or necropsy confirmed the diagnosis); (3) TEE performed during the diagnostic approach.

Clinical and microbiologic evaluation

Age, sex, location, type (biologic or mechanical) of prosthesis involved, and time from prosthesis implantation to onset of symptoms were recorded for all

Patient characteristics

Our group consisted of 87 patients (55 men, mean age 51 ± 12 years [range 28 to 80]) with PVE who underwent TEE. Fifty-seven patients had a prosthesis in the aortic position (47 mechanical and 10 bioprosthesis) and 30 in the mitral position (24 mechanical and 6 bioprosthesis). No patient was an intravenous drug abuser.

Symptoms suggestive of PVE presented within 6 months after surgery (“early” PVE) in 51 patients and >6 months after surgery in 36 (“late” PVE).

Table Ilists the microorganisms

Discussion

Several studies have investigated the impact of the presence of periannular complications on the clinical course of patients with endocarditis.3, 4, 6, 7 Previous studies included predominantly patients with native valve endocarditis; hence, that impact on PVE has not yet been addressed. Some interesting findings emanate from our work. First, periannular complications are more frequent in the aortic position and in early PVE, and neither the type of prosthesis nor the etiologic agent was

References (24)

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