Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality
| العنوان: | Aorto-cavitary fistulous tract formation in infective endocarditis: clinical and echocardiographic features of 76 cases and risk factors for mortality |
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| المؤلفون: | Manuel Anguita, Gabriel Rufi, Carlos González-Juanatey, José Alberto San Román, Joan R. Guma, M. Carmen Fariñas, Enrique Navas, Tomás Ripoll, Isidre Vilacosta, Carlos A. Mestres, Christopher H. Cabell, Artur Evangelista, Patricia Muñoz, Francisco Miralles, Carles Paré, Vance G. Fowler, Benito Almirante, José M. Miró, Rubén Leta, Cristina Sarriá, Ignacio García-Bolao, Ignasi Anguera, Arístides de Alarcón, Elisa de Lazzari |
| المصدر: | European Heart Journal. 26:288-297 |
| بيانات النشر: | Oxford University Press (OUP), 2004. |
| سنة النشر: | 2004 |
| مصطلحات موضوعية: | Adult, Male, Aortic valve, medicine.medical_specialty, Adolescent, Heart Diseases, Population, Aortic Diseases, Risk Factors, Streptococcal Infections, medicine, Humans, Endocarditis, Hospital Mortality, Risk factor, education, Aged, Retrospective Studies, Aged, 80 and over, Vascular Fistula, education.field_of_study, business.industry, Retrospective cohort study, Endocarditis, Bacterial, Middle Aged, Sinus of Valsalva, Staphylococcal Infections, medicine.disease, Surgery, medicine.anatomical_structure, Mycoses, Echocardiography, Aortic Valve, Infective endocarditis, Heart failure, Female, Cardiology and Cardiovascular Medicine, business, Complication |
| الوصف: | Aims To investigate the clinical features, echocardiographic characteristics, management, and prognostic factors of mortality of aorto-cavitary fistulization (ACF) in infective endocarditis (IE). Extension of infection in aortic valve IE beyond valvular structures may result in peri-annular complications with resulting necrosis and rupture, and subsequent development of ACF. Aorto-cavitary communications create intra-cardiac shunts, which may result in further clinical deterioration and haemodynamic instability. Methods and results In a retrospective multi-centre study over 4681 episodes of IE, a total of 76 patients with ACF [1.6%, confidence interval (CI) 95%: 1.2–2.0%] diagnosed by echocardiography or during surgery were identified. Fistulae were found in 1.8% of cases of native valve IE and in 3.5% of cases of prosthetic valve IE from the general population and in 0.4% of drug abusers. PVE was present in 31 (41%) cases of ACF. Transthoracic and transoesophageal echocardiography detected the fistulous tracts in 53 and 97% of cases, respectively. Peri-annular abscesses were detected in 78% of cases, fistulae originated in similar rates from the three sinuses of Valsalva, and the four cardiac chambers were equally involved in the fistulous tracts. Heart failure (HF) developed in 62% of cases and surgery was performed in 66 (87% CI 95% 77–93%) patients with a mortality of 41% (95% CI 30–53%) in the overall population. Multivariate analysis identified HF (OR 3.4, CI 95% 1.0–11.5), prosthetic IE (OR 4.6, CI 95% 1.4–15.4) and urgent or emergency surgical treatment (OR 4.3, CI 95% 1.3–16.6) as variables significantly associated with an increased risk of death. Major complications during follow-up (death, re-operation, or re-admission for HF) among the five operative survivors with residual fistulae occurred in 20 and 100% of patients at 1 and 2 years, respectively. Conclusion Aorto-cavitary fistulous tract formation is an uncommon but extremely serious complication of IE. In-hospital mortality was exceptionally high despite aggressive management with surgical intervention in the majority of patients. Prosthetic IE, urgent surgery, and the development of HF identify the subgroup of patients with IE and ACF that have significantly increased risk of in-hospital death. |
| تدمد: | 1522-9645 0195-668X |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d27a9c476ddc8f068a7d004947cdd64e https://doi.org/10.1093/eurheartj/ehi034 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....d27a9c476ddc8f068a7d004947cdd64e |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15229645 0195668X |
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