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American Journal of Roentgenology, Vol 156, 1155-1158, Copyright © 1991 by American Roentgen Ray Society

ARTICLES

Perivalvular pseudoaneurysm complicating bacterial endocarditis: MR detection in five cases

EW Akins, RM Slone, BN Wiechmann, M Browning, TD Martin and WR Mayfield
Department of Radiology, University of Florida College of Medicine, JHMHC, Gainesville 32610-0374.

Bacterial endocarditis usually affects the valve leaflets, but erosion into the valve anulus and adjacent myocardium may form a myocardial abscess. Perivalvular abscesses can drain into the ventricles or aorta, forming a life-threatening pseudoaneurysm. We reviewed our experience with cardiac MR imaging of this disorder. Fourteen patients with complicated bacterial endocarditis underwent ECG-gated spin-echo cardiac MR imaging in addition to conventional duplex two-dimensional echocardiography (2-D echo). Angiography was performed in seven patients, six of whom underwent surgery for valve replacement. MR imaging detected the pseudoaneurysms in all five of the surgically proved cases, while 2-D echo detected only three. Clinical follow-up suggested there were no false-negative examinations, but no autopsy data were available for confirmation. Postoperative MR imaging studies were conducted in three patients, revealing two recurrent pseudoaneurysms and one thrombosed aneurysm. Cardiac MR imaging provides useful pre- and postoperative information in patients with perivalvular pseudoaneurysms due to endocarditis.
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Copyright © 1991 by the American Roentgen Ray Society.