Clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms

Background. Little information is available on the clinical profile and pro gnosis of patients with endocarditis and periannular pseudoaneurysms becaus e the presence of pseudoaneurysm itself is considered an indication albeit not an evidence-based indication, for surgery. Methods. We followed 18 patients (11 males, mean age: 5 +/- 4) with endocar ditis and pseudoaneurysm diagnosed by transesophageal echocardiography and/ or at surgery over 14 +/- 5 months. Results. Aortic (n = 14; 6 on native valve, 8 on prosthesis) was more frequ ent than mitral (n = 3; 3 prosthesis) or tricuspid location (n = 1). Auricu loventricular block developed in 6 patients, all with aortic pseudoaneurysm . The most frequently involved microorganisms were staphylococci (n = 5) an d streptococci (n = 5). Abscesses were found in 5 patients. Pseudoaneurysm was not considered an indication for surgery. Eleven patients underwent sur gery 5 died after surgery (45%), 1 had reinfection and 5 are asymptomatic. The remaining 7 patients received only medical treatment: two died (28%), o ne developed reinfection and 4 are asymptomatic. The size of the pseudoaneu rysm remained stable after 24 months of follow-up in the 4 asymptomatic med ically treated patients (maximal diameter: 21 +/- 5 at diagnosis versus 22 +/- 5 at latest follow-up; p = NS). Conclusions. We conclude that the presence of a pseudoaneurysm identifies a subset of endocarditis patients with a high mortality. Pseudoaneurysms are usually located in an aortic position and around prosthetic material. Medi cal treatment without surgery should be considered when no other surgical i ndications exist. Lastly the size of a pseudoaneurysm in medically treated patients does not increase over time.