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

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 echoca rdiographic accuracy In detecting periannular complications in prosthetic r ecipients remains unsettled. We retrospectively analyzed data from 87 patie nts with anatomically proven prosthetic valve endocarditis who underwent a transesophageal echocardiographic examination. Periannular complications (3 0 abscesses, 18 pseudoaneurysms, 8 fistulas; 8 with >1) were found in 46 pa tients; results were compared with the remaining 41 without complications. Transesophageal echocardiography correctly identified 27 abscesses (90%) an d all pseudoaneurysms and fistulas. One diagnosis of pseudoaneurysm by echo cardiography was not found at surgery. No statistical differences were foun d regarding age, sex, type of prosthesis (mechanical vs biologic), and etio logic agent. Periannular complications were more frequent in aortic locatio n (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). Th e 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 en docarditis are more frequent in aortic location and within 6 months after s urgery. Neither the type of prosthesis nor the etiologic agent are related to the presence of periannular complications. Short-term prognosis in patie nts who underwent surgery is not affected by the presence of periannular co mplications. (C) 1999 by Excerpta Medica, Inc.