Original articleAdult cardiacImpact of Early Surgical Treatment on Postoperative Neurologic Outcome for Active Infective Endocarditis Complicated by Cerebral Infarction
Section snippets
Patient Selection
This retrospective study protocol was approved by the institutional review board of each hospital as well as the Ethics Committee of Osaka University Hospital. Using the Osaka Cardiovascular Research Group database, 150 patients who underwent valve operations for active IE from 2005 to 2010 were identified. In these 150 patients, 102 patients who underwent preoperative cephalic DW-MRI evaluations before operation were enrolled in this study. The decision for MRI evaluation depended mainly on
Clinical Characteristics
Of 102 patients, 35 patients (34.3%) had preoperative CI symptoms. The relationships between preoperative CI symptoms and the prevalence of acute CI are shown in Fig 2. Nearly all patients with existing CI symptoms (34 of 35 [97.1%]) had acute CIs, whereas the 1 patient without acute CI had a subarachnoid hemorrhage. Even in patients without existing CI symptoms, 30 of 67 (44.8%) had at least 1 acute CI revealed by DW-MRI. In those patients with acute CI, the maximum length of the CIs was
Comment
Bacterial CI is a major complication of IE and about 20% to 30% of patients with IE have a neurologically symptomatic stroke [1, 6, 14, 15, 16]. However several previous studies that used MRI reported that the incidence of central nervous complications in patients with IE was much more frequent than their neurologic symptoms would suggest [9, 10, 17, 18]. In those reports, even in patients without a clinically overt stroke, MRI findings revealed that 40% to 70% had silent acute CIs. In the
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