Abstract
Abstract only
Introduction:
A complication of infectious endocarditis (IE) is infectious intracranial aneurysm (IIA, or mycotic aneurysm). Diagnosis and resolution of IIA prior to cardiac valve repair in IE patients is thought to reduce the risk of IIA rupture during perioperative anticoagulation. We report a series of patients undergoing cardiac valve replacement with unresolved IIAs.
Methods:
The study was designed as a review of medical records at a single tertiary referral center from 2011-2016. A total of 618 patients with infective endocarditis undergoing cerebral angiogram were reviewed. Patients with secured unruptured IIA prior to surgery were compared to patients with unsecured unruptured IIA prior to surgery. Perioperative intracranial hemorrhage and death were compared between the two groups.
Results:
Of 27 patients with IIA undergoing valve surgery, 7 (26%) had preoperative unsecured aneurysms, while 20 (74%) had angiographically resolved or occluded aneurysms (14 resolved by endovascular occlusion, 6 by antibiotics). The 7 unsecured IIAs were not resolved for various reasons (3 had high risk of vessel sacrifice, 1 had small size, 3 had patient clinical instability). Median time from last angiogram to valve surgery was 7 days (IQR 2-8) in the unsecured group, and 5.5 days (IQR 3-9) for secured group. There was no postoperative subarachnoid hemorrhage (SAH) or aneurysmal rupture seen in either group. Perioperative hemorrhagic transformation of a subacute ischemic stroke was observed in one patient in each group (14% versus 5%, p=0.46). There were no deaths or further bleeding in the unsecured aneurysm group.
Conclusion:
There was no post-operative death or SAH seen in seven patients undergoing cardiac valve surgery with unsecured IIA.