Objective To summarize the clinical characteristics of patients with infectious endocarditis (IE) associated infectious aneurysm (IIA) and share the experience in diagnosis and treatment. Methods A retrospective analysis was conducted on the clinical data of 554 patients who underwent cardiac surgery for IE at the Department of Cardiology, Guangdong Provincial People's Hospital from September 2018 to August 2023. Patients with secondary IIA were screened. According to the treatment plan of IIA, patients are divided into a simple anti infection group and an endovascular treatment group. Results Finally, 31 patients with IE secondary IIA were included, including 21 males and 10 females, with a median age of 33 (26, 53) years. Fifteen patients had no obvious neurological symptoms before diagnosis of IIA. The IIA treatment plan for 7 patients was simple anti infective therapy; 24 patients received anti infection and endovascular embolization treatment, of which 23 patients achieved technical success. Nine patients underwent simultaneous combined surgery with an interval of 2 (0, 6) days between IIA endovascular embolization and open heart surgery. Three patients in the simple anti infection group experienced IIA rupture and bleeding, and died on the day of automatic discharge. One patient in the endovascular treatment group experienced aneurysm rupture and died. All patients recovered well after surgery and did not show any new neurological symptoms. Conclusion IE patients should pay attention to head imaging examination to screen for IIA. In addition to regular anti infection measures, intracavitary therapy can be considered as a reasonable treatment plan for IIA in IE patients with indications for cardiac surgery.
Intracranial hemorrhage (ICH) represents a severe complication of infective endocarditis (IE) and stands as a significant contributor to the poor prognosis associated with IE. Current guidelines suggested a delay of 4 weeks for cardiac surgery in patients with ICH, but these recommendations were based on insufficient clinical evidence, and recent studies have yielded different opinions. In this paper, we thoroughly reviewed relevant guidelines and their references in conjunction with 3 typical cases with IE and ICH, discussed the recommendations with controversy, and proposed a process for the management of IE with ICH.