OBJECTIVE:Our primary endpoint was to determine the prevalence of superior mesenteric artery aneurysms (SMAAs) in infectious endocarditis (IE) patients. METHODS:Retrospective study of 474 IE-patients (2005-2020) with abdominal computed tomography-angiography (CTA): the data of 10 SMAA-IE-patients (2.1%) are analyzed. RESULTS:The median age of the 10 patients was 50.4 years (6 men). Microorganisms were Streptococcus spp. (n=6), Gemella spp. (n=2), Staphylococcus aureus (n=1), Enterococcus faecalis (n=1). Aneurysms were saccular (n=9), fusiform (n=1). Five SMAAs were partially thrombosed. Three patients presented acute abdominal pain, associated with partial thrombosis. Three became symptomatic: SMAA growth (n=2) and delayed aneurysm, enlargement, rupture, and bowel ischemia (n=1). Four were small (<25 mm), 6 were large (25-70 mm), mostly distally located (6/10). Five (3 small, 2 large) regressed under antibiotic therapy alone, 2 (25 and 40 mm) underwent coil embolization. Three underwent surgery (30, 50, and 60 mm), because of large aneurysm at SMA origin, rapid enlargement and rupture, and bowel ischemia. The outcome was favorable (mean follow-up: 43.5 months; range: 9-72). CONCLUSION:Abdominal pain, vomiting, diarrhea, occurring in a patient with a current or recent history of IE should be carefully evaluated by CTA. Symptomatic, growing aneurysms and fusiform aneurysms mainly underwent an operative repair. Five silent aneurysms (<20 mm, n=2; >20 mm, n=3) were safely monitored under antibiotic therapy, enhancing the need to further have cross-sectional imaging of the visceral circulation in all cases of left-sided IE to detect asymptomatic aneurysms. SMAAs can regress, thus conservative management of small asymptomatic ones is possible.Clinical ImpactIn our series of superior mesenteric artery infectious aneurysms (SMAA) in infective endocarditis (IE) patients (incidence: 2.1%), symptomatic, growing aneurysms and fusiform aneurysms mainly underwent an operative repair. Five silent aneurysms (<20mm, n=2; >20mm, n=3) were safely monitored under antibiotic therapy. Our study showed first, the need to have cross-sectional imaging of the visceral circulation in all cases of left sided infective endocarditis. Obviously, abdominal CT-angiography monitoring is also a cornerstone of the efficacy of the antibiotic regimen. Second, SMAAs in IE patients can regress: thus conservative management of small asymptomatic ones is possible.

Unusual course of Serratia marcescens (SM) infectious endocarditis (IE) and literature review (2016-2024; 26 cases).A 44-year-old man, with chronic venous ulcers, presented 21/2 years after a MSSA tricuspid valve IE, a tricuspid and aortic valves SM IE . After 6 weeks of antibiotherapy (meropenem i.v., 2g/6h), he presented a relapse (same sensitivity pattern), complicated by tibio-peroneal trunk aneurysm. He underwent a biological tricuspid valve replacement.Fifteen months later, he presented a recurrent SM IE, (same sensitivity pattern), complicated by a popliteal artery aneurysm. An aortic-tricuspid bioprosthetic valve replacement was performed. At one-year, there was no sign infection.The occurrence of both relapsing and recurrence, and of infectious aneurysms in SM IE are highlighted. However, these findings must be interpreted with caution, due to the lack of molecular typing.Literature shows that a regimen combining a beta-lactam and either fluoroquinolone or an aminoglycoside seems to warrant a less mortality rate.

BACKGROUND AND PURPOSE:Systematic brain magnetic resonance imaging (MRI) reveals lesions in almost all patients with infective endocarditis (IE), but their long-term evolution and clinical impact have not been investigated. We aimed to describe the evolution of cerebral lesions detected by systematic MRI during acute IE and to assess their clinical consequences during follow-up. METHODS:We conducted a single-center observational prospective study nested into the ECHO-IMAGE cohort, comparing systematic brain MRIs performed during a follow-up visit with those performed during the IE episode. We analyzed cerebral lesions evolution and their association with patients' functional disability, cognitive impairment, depression and quality of life. RESULTS:Among the 100 included patients who underwent the follow-up visit after a median of 37 [21-74] months after the initial episode of IE, MRI neurological lesions were found in 80% of cases at follow-up, as compared to 84% during the IE episode. Most of these lesions were stable or decreased over time, except for the number of cerebral microbleeds, which increased significantly. At follow-up, functional disability, cognitive impairment, and depression were observed in 4%, 14%, and 59% of cases, respectively. Quality of life remained significantly altered in 3 dimensions, as compared to a control general French population. No association was found between the presence of cerebral lesions, the severity of IE episode and outcomes. CONCLUSION:Cerebral lesions on systematic MRI are frequent during IE, and their evolution is stable over time, with the exception of cerebral microbleeds. We observed no association between cerebral lesions and long-term clinical consequences of IE.

Background: To study whether infective endocarditis patients (IE-patients) with visceral embolic events (VEEs) at admission are at greater risk of developing visceral infectious aneurysms (VIAs) in left-sided infective endocarditis (LSIE) patients. Methods: We compared the data of prospectively collected 474 consecutive LSIE-patients (2005–2020) with and without VIAs. A whole-body-CTA was part of the initial work-up for all patients. Results: A total of 24 patients (5.1%) with VIA were included, of whom 19 (79.2%) had at least one VEE, compared to a proportion of 34% (p < 0.001) in IE-patients without VIAs. Both groups also differed in terms of vegetation size (>15 mm: 48% vs. 18%, p < 0.001), microorganisms, Streptococcus spp. (68.5% vs. 42%, p = 0.003), rare microorganisms (36% vs. 8.3%, p < 0.001) and concomitant extra-visceral infectious aneurysms (42% vs. 12.8%, p < 0.001). Cardiac surgery was performed in 21 patients (87.5%) and in-hospital mortality occurred in 2 (8%). Conclusions: This study shows a different profile of VIA–LSIE patients compared to LSIE-patients without. Streptococcus species were the most frequent causal agents. Our study indicates that the presence of VEEs in LSIE-patients could suggest an increased risk of VIA. This study also shows the need for further abdominal-CTA in all cases of left sided IE to detect asymptomatic visceral aneurysms.

BACKGROUND:Combining pretest probability (PTP) with computed tomography angiography (CTA) for diagnosing obstructive coronary artery disease (CAD) has not yet been determined. OBJECTIVES:The purpose of this study was to evaluate the accuracy of PTP calculation alone and with CTA for diagnosing CAD. METHODS:A total of 65 prospective diagnostic accuracy studies of patients clinically referred to invasive coronary angiography with stable chest pain were included in this international collaborative individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT) meta-analysis. Mixed-effects logistic regression with a data set-specific random intercept for clustering was applied to 4 models: the traditional Diamond-Forrester models, a PTP model based on the COME-CCT data (termed COME-CCT-PTP calculator), a CTA alone model, and a combined COME-CCT-PTP with CTA model. RESULTS:Individual patient data from 5,332 patients with clinically indicated invasive coronary angiography from 22 countries were included. The COME-CCT-PTP calculator was more accurate than the original Diamond-Forrester model (AUC: 0.68; 95% CI: 0.66-0.69 vs 0.63; 95% CI: 0.62-0.65). The COME-CCT-PTP with CTA model significantly improved accuracy compared with either model alone (AUC: 0.86; 95% CI: 0.85-0.87 vs 0.81; 95% CI: 0.80-0.82). The improved prediction was consistent in decision curve analysis with an increased net benefit for all chest pain subtypes and was almost equally seen in patients with typical or atypical angina (0.85; 95% CI: 0.84-0.86) and nonanginal or other chest discomfort (0.88; 95% CI: 0.86-0.89). CONCLUSIONS:Combining the COME-CCT-PTP calculator with CTA provides more accurate prediction than the PTP or CTA alone for the diagnosis of obstructive CAD, for all chest pain subtypes.

We report an exceptional case of a large right persistent proatlantal artery (PPPA), defined as a "mixed" type, because it originated as in Type 2 from the external carotid artery and courses as in Type1, i.e. over the vertebral artery groove of the posterior arch of C1, entering the skull via the foramen magnum, without passing through the transverse foramen of any of the cervical vertebra. This "mixed" PPPA was associated first with an azygos anterior cerebral artery and second with a left common carotid artery arising from the brachiocephalic trunk. The right occipital artery arose from the PPPA. In addition, an aneurysm arose from the kinked right cervical internal carotid artery. This case illustrated an association not reported previously, making treatment of the concomitant aneurysm challenging. Moreover, understanding of persistent carotid-vertebral anastomosis is essential to enable evaluation and management before performing endovascular treatment, especially in cases of basilar thrombectomy and for posterior circulation strokes.

Background: To determine the prevalence, the clinical and radiological features, associated factors, treatment, and outcome of splenic artery aneurysms (SAAs) in infective endocarditis (IE). Methods: We retrospectively reviewed 474 consecutive patients admitted to our institution with definite IE (2005-2020). Results: Six patients had SAAs (1.3%; 3 women; mean age: 50 years). In all cases, the diagnosis was obtained by abdominal computed tomography angiography (CTA). SAAs-IE were solitary and saccular with a mean diameter of 30 mm (range: 10-90 mm). SAAs-IE were intrasplenic (n = 4) or hilar (n = 2). Streptococcus spp. were the predominant organisms (n = 4). In all cases, a left-sided native valve was involved (aortic, n = 3; mitral, n = 2; mitral-aortic, n = 1). SAAs were silent in half patients and were revealed by abdominal pain (n = 2) and by the resurgence of fever after cardiac surgery (n = 1). All patients underwent emergent valve replacement. One patient died within 24 hr from multiorgan failure. For the others, uneventful coil embolization was performed in 4 patients after valve replacement (3 diagnosed early and 1 at 8 weeks). In the remaining patient, SAA-IE diagnosed at abdominal CTA at day 16, with complete resolution under appropriate antibiotherapy alone. Conclusions: SAAs-IE are a rare occurrence that may be clinically silent. SAAs-IE can be intrasplenic or hilar in location. Endovascular treatment in this context was safe. According to current guidelines, radiologic screening by abdominal CTA allowed the detection of silent SAAs which could be managed by endovascular treatment to prevent rupture. The delayed formation of these SAAs could justify a CTA control at the end of antibiotherapy.

BackgroundHepatic artery aneurysms (HAAs), albeit rare in infective endocarditis (IE), are associated with a life-threatening morbidity.MethodsRetrospective review of 10 HAA-IE-patients based on a total of 623 IE-patients managed in two institutions (2008-2020) vs 35 literature’ cases.ResultsIn our patient population, HAAs (10 males, mean-age 48) were incidentally found during IE-workup. All were asymptomatic. IE involved mitral (n=6), aortic (n=3), or mitral-aortic valve (n=1). Predisposing factors for IE were: prosthetic valve (n= 6), previous IE (n=2), IV drug user (n=1). Streptococcus spp were predominant (n=4), then staphylococcus spp (n=2) and E. faecalis (n=2).All patients presented associated lesions: infectious aneurysms (n=5), emboli (n=9), abscesses (n=5) and spondylitis/spondylodiscitis (n=2).HAA patterns on abdominal CT-Angiography (CTA) were solitary (70%), mean diameter 11.7mm (range 2-30), intrahepatic location (100%) involving the right HA in 9/10 (90%) patients. In 2 patients HAAs were complicated (rectorragia and hemobilia in 1, cholestasis in the other). Six patients underwent endovascular hepatic embolization (2 with multiple HAAs). Three HAA-IEs <15mm resolved under antibiotherapy on abdominal CTA follow-up. All patients underwent cardiac surgery. Late outcome was favorable in all followed patients (5/10).Literature review showed the preponderance of Streptococcus spp., of right lobe and intrahepatic HAA localization. Complications revealed HAAs in patients under antibiotic therapy and/or after cardiac surgery in 17 literature’ cases of delayed diagnosis.ConclusionAbdominal CTA was pivotal in the initial IE work-up. Small aneurysms (≤15mm) resolved under antibiotherapy. The usual treatment modality was HAA embolization and endovascular embolization prior to valve surgery was safe.

Background The prevalence and location of coronary artery disease (CAD) in anomalous aortic origin of a coronary artery (AAOCA) remain poorly documented in adults. We sought to assess the presence of CAD in proximal (or ectopic) and distal (or nonectopic) segments of AAOCA. We hypothesized that the representation of CAD may differ among the different courses of AAOCA. Methods The presence of CAD was analyzed on coronary angiography and/or coronary computed tomography angiography in 390 patients (median age 64 years; 73% male) with AAOCA included in the anomalous coronary arteries multicentric registry. Results AAOCA mainly involved circumflex artery (54.4%) and right coronary artery (RCA) (31.3%). All circumflex arteries had a retroaortic course; RCA mostly an interarterial course (98.4%). No CAD was found in the proximal segment of interarterial AAOCA, whereas 43.8% of retroaortic AAOCA, 28% of prepulmonic AAOCA and 20.8% subpulmonic AAOCA had CAD in their proximal segments (P < 0.001). CAD was more prevalent in proximal than in distal segments of retroaortic AAOCA (OR: 3.1, 95% CI: 1.8–5.4, P < 0.001). On multivariate analysis, a retroaortic course was associated with an increased prevalence of CAD in the proximal segment (adjusted OR 3.4, 95% CI: 1.3–10.7, P = 0.022). Conclusion Increased prevalence of CAD was found in the proximal segment of retroaortic AAOCA compared to the proximal segments of other AAOCA, whereas no CAD was observed in the proximal segment of interarterial AAOCA. The mechanisms underlying these differences are not yet clearly identified.

Background: Functional assessment of compact myocardium and hypertrabeculations in left ventricular non-compaction (LVNC) is underestimated with regards to the morphological spectrum of disease. We aimed to assess whether measuring concurrently left ventricular (LV) volume, mass and ejection fraction (LVEF) with and without trabeculation inclusion on cine magnetic resonance (cineMR) could help diagnose patients with LVNC by comparison to normal individuals with an excess of myocardial trabeculations. Methods: This retrospective single center magnetic resonance imaging study (Bichat University Hospital) of 67 consecutive patients with echocardiographic hypertrabeculations seen at echocardiography between March 2011 and October 2018 included 30 patients with known LVNC and 16 control subjects with simple hypertrabeculations (non-compact/compact (NC/C) ratio between 1.8 and 2.2, trabeculations involving 10% to 17% of the left ventricle) using steady-state free precession (SSFP) cine sequences in the standard views. LV volumes, mass and LVEF were measured with and without trabeculation inclusion using CVI42 software. Follow-up was studied in 20 patients and 14 controls. Functional parameters were compared using Student's paired t-test. Pearson product moment correlation coefficients were calculated. Bland-Altman analysis determined the inter- and intra-reader functional data reproducibility. Results: When excluding the trabeculations (i.e. non-compacted myocardium) from measurements, LVEF was within normal ranges both in patients and controls, while it increased by 9.8%+/- 1.6% in LVNC and decreased by 10.9%+/- 1.4% in controls when trabeculae were included in the endocardial contours (P<0.0001). The overall myocardial mass remained stable according to the diastolic or systolic phase in LVNC whereas it significantly decreased in controls. Conclusions: Depending whether trabeculations were included or not, LVEF measurements were significantly different between patients with LVNC and controls. These distinctive measurements might be used as an adjunctive clinical tool to help confirm the diagnosis of LVNC.

Background: Aneurysms of the internal iliac artery in infective endocarditis are extremely rare, with few cases reported in the literature, and Rothia dentocariosa infective endocarditis are rare. Analysis: We describe the case of a previously healthy 62-year-old male who presented a Rothia dentocariosa infective endocarditis. Results: Multi-modality imaging revealed an aneurysm of the left internal iliac artery, which was clinically silent. The patient was treated with antibiotics and semi-emergent bioprosthesis aortic valve replacement. Follow-up multi-modality imaging showed the regression of the aneurysm. Conclusion: This case shows that an aneurysm of the internal iliac artery in infective endocarditis can regress under antibiotherapy alone. This case also highlights the ability of PET/CT to identify and follow such an aneurysm.

To determine the background, bacteriological, clinical and radiological findings, associated lesions, treatment and outcome of splenic abscesses (SAs) in infective endocarditis (IE). Retrospective study (2005–2021) of 474 patients with definite IE. The diagnosis of SA was made in 36 (7.6

We report in-vivo imaging of a constellation of arterial variants found incidentally on CT-angiography in a 23-year-old woman presenting with an ischaemic stroke. This extremely rare combination includes a common origin of both common carotid arteries, an abnormal origin of the right vertebral artery (VA) from the right common carotid artery and of the left VA from the aortic arch, associated with an aberrant right subclavian artery. This constellation, previously described in a female cadaver, has not been reported in-vivo. Awareness of this configuration is crucial for radiological diagnosis and when performing angiography and endovascular or surgical procedures in thorax, head and neck, to avoid complications.

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature. We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts. He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization. This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

Surgical InfectionsVol. 24, No. 5 Letters to the EditorLetter to the Editor: Multiple Brain Abscesses in Hemophilus parainfluenzae Endocarditis: A Case ReportMonique Boukobza, Emila Ilic-Habensus, Xavier Duval, and Jean-Pierre LaissyMonique BoukobzaAddress correspondence to: Dr. Monique Boukobza, Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75018 Paris, France E-mail Address: m.boukobza@orange.frDepartment of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.Search for more papers by this author, Emila Ilic-HabensusClinical Investigation Center, Assistance Publique-Hôpitaux de Paris, Bichat Claude-Bernard Hospital, Paris, France.Search for more papers by this author, Xavier DuvalDepartment of Infectious Diseases, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.INSERM Clinical Investigation Center 007, Paris, France.Search for more papers by this author, and Jean-Pierre LaissyDepartment of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.INSERM U1148, Paris, France.Paris University, Paris, France.Search for more papers by this authorPublished Online:5 Jun 2023https://doi.org/10.1089/sur.2022.369AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 24Issue 5Jun 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Monique Boukobza, Emila Ilic-Habensus, Xavier Duval, and Jean-Pierre Laissy.Letter to the Editor: Multiple Brain Abscesses in Hemophilus parainfluenzae Endocarditis: A Case Report.Surgical Infections.Jun 2023.501-504.http://doi.org/10.1089/sur.2022.369Published in Volume: 24 Issue 5: June 5, 2023Online Ahead of Print:February 28, 2023PDF download

Brain abscesses (BA) are severe lesions in the course of infective endocarditis (IE). We compare the bacteriological, clinical data, background, associated lesions, and outcome of IE patients with and without BAs, and assess the MRI characteristics of BAs. Retrospective study of 351 consecutive patients with definite IE (2005–2020) and at least one brain MRI. Patients with and without BAs were compared. Twenty patients (5.7

Purpose: To evaluate the usefulness of T2* and FLAIR sequences in the detection of unruptured infectious intracranial aneurysms (UIIAs) in infective endocarditis (IE) including the relationships between the lesion patterns within subarachnoid spaces and the presence of UIIA. Methods: Retrospective review of 15 consecutive patients with definite IE undergoing MR imaging (FLAIR, T2*, DWI, CE-MRA, 3D-T1, CE-3DT1 sequences), in whom DSA detected infectious intracranial aneurysms (IIA). Aneurysmal features (diameter, location, morphology on DSA) and signal patterns onT2*, FLAIR and conventional MR sequences at the site of the UIIA, follow-up MRI and IE background, were analyzed. A control-group of 15 IE-patients without IIA at DSA served for comparison. Results: Among 17 UIIAs studied, T2* sequence displayed a susceptibility vessel sign in 15/17 (88.2%), both distal and proximal, which matched with the IIA visualized on DSA. Three patterns of hyposignal areas were identified: (a) signet-ring or target-sign appearance (n = 7), (b) homogeneous, round-, oval- or pear-shaped area (n = 4), and (c) heterogeneous area (n = 4). A FLAIR hyperintensity of the lumen and of the adjacent cortex was present in 6 (35.3%) and 9 (53%) UIIAs, respectively. On T1 (12 UIIAs) a rounded hyposignal (n = 2), within the UIIA lumen matched with the FLAIR hypersignal. Using both T2* and FLAIR had an incremental value with 100% sensitivity and specificity. Conclusion: The susceptibility vessel sign is an MR imaging pattern frequently observed at the site of UIIAs in IE-patients. Both T2* and FLAIR may have the potential to depict UIIAs, regardless of their location and shape. (c) 2022 Elsevier Masson SAS. All rights reserved.