Periannular extension of infective endocarditis.

The periannular extension of infection is one of the most dangerous complications in patients with infective endocarditis (IE) and can significantly impact on the prognoses of these patients. The accurate detection and delineation of periannular complications are crucial in patient management, which may also provide guidance for surgical intervention. Echocardiography is the preferred imaging examination in both native and prosthetic valvular infections. However, it remains a great challenge for surgeons to successfully treat infections from panresistant organisms. Although staphylococci are reported to be the most common cause of aorto-cavitary fistulae, the association between this pathogen and clinical characteristics and patient outcome remains to be proven. Conversely, it has been observed that S. aureus is the most common cause of aorto-cavitary fistulae in patients with native valve endocarditis. The optimal management of patients with periannular extension of IE requires a multidisciplinary approach, with surgical input being an integral part of the treatment associated with the evolution of complex reconstructive techniques.