Abstract Details

Mycotic aneurysms are a significant complication of infective endocarditis that can lead to intracranial hemorrhage (ICH) and occasionally require intervention prior to valvular surgery. Digital subtraction angiography (DSA) remains the gold standard for detection of mycotic aneurysm but is an invasive procedure with dye exposure.

Determine predictive factors for the presence of mycotic aneurysms in patients with known infective endocarditis. 

IRB exemption was obtained from the University of Pittsburgh Medical Center. Patients with left-sided or right-sided definite endocarditis with patent foramen ovale (PFO) were identified.  Records were retrospectively reviewed by an independent investigator. Patients were stratified by demographic information, workup, and outcomes. Standard descriptive statistics were used for characterization. Chi² analysis, Fisher Exact test were used for categorical comparisons. Student t-test was used for group comparisons.

Between 9/1/2020 – 6/30/2021, 36 cases of left-sided or right-sided endocarditis with PFO in 35 patients were identified. 24 patients underwent DSA. Patients with neurological symptoms (n=20) or those who underwent CNS imaging (n=25) were more likely to have DSA performed. Six patients were found to have ICH on CNS imaging.  Mycotic aneurysms were identified in 5 patients, all of whom had pre-operative CNS imaging which demonstrated ICH.  Mycotic aneurysms were not identified in any patients who did not have ICH on CNS imaging (p<0.0001). DSA was associated with lower rates of valve surgery (OR 0, 95% CI 0-0.856, p=0.0334).  While not statistically significant, DSA was associated with higher in-hospital mortality, while CNS imaging was associated with decreased rates of surgery and mortality. Initial neurological symptoms was associated with decreased rates of surgery and slightly increased mortality.

Patients with left-sided and right-sided endocarditis with PFO and ICH were more likely to have mycotic aneurysms than similar patients without ICH.