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Periannular extension of infective endocarditis

Catherine Graupner, MD^*, Isidre Vilacosta, MD^*,*, JoséAlberto SanRomán, MD, Ricardo Ronderos, MD, Cristina Sarriá, MD, Cristina Fernández, MD^*, Ricardo Mújica, MD, Olga Sanz, MD, Juan Victor Sanmartín, MD and Angel González Pinto, MD^||

^* Hospital Universitario San Carlos, Madrid, Spain
Hospital Universitario de Valladolid, Valladolid, Madrid, Spain
Hospital de la Princesa, Madrid, Spain
^|| Hospital Ruber Internacional, Madrid, Spain
Hospital San Juan de Dios, La Plata, Argentina

View larger version (69K): [in a new window]   Figure 1 (A) Anatomic specimen of prosthetic aortic valve endocarditis. Several perivalvular pseudoaneurysms (*) can be observed. (B) Echocardiographic imaging by transesophageal echocardiography of the same patient as in A. The perivalvular pseudoaneurysms (*) are well seen. Aortic vegetations (arrow) can also be visualized. AD = right atrium; AI= left atrium; VD= right ventricle.

View larger version (97K): [in a new window]   Figure 2 Transesophageal echocardiographic images of prosthetic aortic valve endocarditis. A huge echodense perivalvular cavity (*) without flow in its interior (abscess) is well seen. AD = right atrium; AI = left atrium; AP = pulmonary artery; VD = right ventricle.

View larger version (61K): [in a new window]   Figure 3 Transesophageal echocardiographic image of aortic endocarditis. A perivalvular cavity (*) with flow in its interior (pseudoaneurysm) can be observed. AI = left atrium; AO = aorta; AP = pulmonary artery; O = left atrial appendage.

View larger version (23K): [in a new window]   Figure 4 Univariate and adjusted relative risk (RR) of periannular complications in 211 patients with left-sided endocarditis. On univariate analysis, there are six variables related to periannular complications: prosthesis, aortic position, small vegetation size (9 mm), coagulase-negative staphylococci (Staph C), atrioventricular (AV) block and previous endocarditis. In the final model, the variables that were independently related to the development of periannular complications were prosthesis, aortic position, coagulase-negative staphylococcal infection and the development of AV block. CI = confidence interval; TEE = transesophageal echocardiography.