Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality

Anguera, Ignasi; Miró, José M.; Vilacosta, Isidre; Almirante, Benito; Anguita, Manuel; Muñóz, Patricia; Román, José Alberto San; Alarcón, Arı́stides de; Ripoll, Tomás; Navas, Enrique; González‐Juanatey, Carlos; Cabell, Christopher H.; Sarriá, Cristina; García‐Bolao, Ignacio; Fariñas, M.C.; Leta, Rubén; Rufí, Gabriel; Miralles, Francisco Felip; Paré, Carles; Evangelista, Artur; Fowler, Vance G.; Mestres, Carlos A.; Lazzari, Elisa de; Gumà, Joan Raimón

doi:10.1093/eurheartj/ehi034

Cited by 214 publications

(106 citation statements)

References 26 publications

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“…300 Periannular extension is common, occurring in 10% to 40% of all NVE and complicating aortic IE more commonly than mitral or tricuspid IE. [301][302][303][304] Periannular infection is of even greater concern with PVE, occurring in 56% to 100% of patients. 298,302 Perivalvular abscesses are particularly common with prosthetic valves because the annulus, rather than the leaflet, is the usual primary site of infection, especially in early PVE and on bioprosthetic valves.…”

Section: Periannular Extension Of Infectionmentioning

confidence: 99%

“…Persistent bacteremia or fever, recurrent emboli, heart block, heart failure, or a new pathological murmur in a patient with IE on appropriate antibiotics may suggest extension. 303 Only aortic valve involvement and current IDU have been prospectively identified as independent risk factors for perivalvular abscess. 297 On ECG, new atrioventricular block has a positive predictive value of 88% for abscess formation but low (45%) sensitivity.…”

Section: Periannular Extension Of Infectionmentioning

confidence: 99%

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Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

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2,537

1,421

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Background— Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. Methods and Results— This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. Conclusions— Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

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Section: Periannular Extension Of Infectionmentioning

confidence: 99%

Section: Periannular Extension Of Infectionmentioning

confidence: 99%

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

Self Cite

2,537

1,421

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“…On both TTE and TEE, paravalvular extension may be detected when a complication like abscess or fistula occurs (22)(23)(24). Fortunately, in the current study it was possible to detect the paravalvular extension of the infection by MRI, depicting delayed contrast enhancement on the paravalvular tissues in six patients before complications arose (Figs.…”

Section: Discussionmentioning

confidence: 56%

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

Dursun

Yılmaz²,

Yılmaz³

et al. 2015

Diagn Interv Radiol

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ORIGINAL ARTICLE PURPOSEWe aimed to evaluate the utility of cardiac magnetic resonance imaging (MRI) for the diagnosis of infective endocarditis (IE). METHODSSixteen patients with a preliminary diagnosis of IE (10 women and six men; age range, 4-66 years) were referred for cardiac MRI. MRI sequences were as follows: echo-planar cine true fast imaging with steady-state precession (true-FISP), dark-blood fast spin echo T1-weighted imaging, T2-weighted imaging, dark-blood half-Fourier single shot turbo spin echo (HASTE), and early contrast-enhanced first-pass fast low-angle shot (FLASH). Delayed contrast-enhanced images were obtained using three-dimensional inversion recovery FLASH after 15±5 min. The MRI features were evaluated, including valvular pathologies on cine MRI and contrast enhancement on the walls of the cardiac chambers, major thoracic vasculature, and paravalvular tissue, attributable to endothelial extension of inflammation on contrast-enhanced images. RESULTSFourteen valvular vegetations were detected in eleven patients on cardiac MRI. It was not possible to depict valvular vegetations in five patients. Vegetations were detected on the aortic valve (n=7), mitral valve (n=3), tricuspid and pulmonary valves (n=1). Delayed contrast enhancement attributable to extension of inflammation was observed on the aortic wall and aortic root (n=11), paravalvular tissue (n=4), mitral valve (n=2), walls of the cardiac chambers (n=6), interventricular septum (n=3), and wall of the pulmonary artery and superior mesenteric artery (n=1). CONCLUSION Valvular vegetation features of IE can be detected by MRI. Moreover, in the absence of vegetations, detection of delayed enhancement representing endothelial inflammation of the cardiovascular structures can contribute to the diagnosis and treatment planning of IE.

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“…Perforation or fistula formation can represent sequelae of uncontrolled infection from either periannular extension or abscess formation. [4] TEE identified the perforation but failed to detect the mural abscess found intraoperatively showing the limitations of these imaging studies.…”

Section: Discussionmentioning

confidence: 94%

The advantages and limitations of echocardiography in a unique presentation of double-sided endocarditis from intravenous drug use

Alencherry

Sullivan

Hoit

2016

CRIM

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A 25-year-old female intravenous drug user presented with a three-week-history of fever and myalgias and was found to have infective endocarditis affecting the mitral and tricuspid valves. Blood cultures grew methicillin sensitive Staphylococcus aureus. Computed tomography showed emboli in multiple organs. Transthoracic echocardiogram revealed large vegetations on the mitral valve with moderate valvular regurgitation and a transesophageal echocardiogram identified a posterior mitral leaflet perforation. The patient underwent urgent surgical intervention after developing respiratory distress from worsening congestive heart failure. Intraoperative findings in addition to those found on echocardiography included a large abscess in the posterior wall of the left atrium. The patient underwent mitral and tricuspid valve replacement due to valve damage. This case shows a unique presentation of valvular involvement of infective endocarditis and the capabilities and limitations of echocardiography in assessing the extent of disease in this condition.

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Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality

Cited by 214 publications

References 26 publications

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

The utility of cardiac MRI in diagnosis of infective endocarditis: preliminary results

The advantages and limitations of echocardiography in a unique presentation of double-sided endocarditis from intravenous drug use

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