Perivalvular abscesses associated with endocarditis. Clinical features and diagnostic accuracy of two-dimensional echocardiography.
OBJECTIVE
To determine the clinical implications of the development of a perivalvular abscess in the course of an infective endocarditis and evaluate the utility of two-dimensional echocardiography in the diagnosis of this complication.


METHODS
Retrospective clinical review. Investigator-blinded comparative echographic case-control study.


METHODS
Tertiary referral center.


METHODS
Forty patients with infective endocarditis and a histologically proved diagnosis of perivalvular abscess.


METHODS
Two-dimensional echocardiograms corresponding to 36 of these 40 patients were blindly compared with two-dimensional echocardiograms of 20 randomly chosen patients with infective endocarditis in whom myocardial abscesses had not been demonstrated during surgery.


RESULTS
During surgery or at autopsy, 40 patients had a total of 41 definite perivalvular abscesses. Native valve endocarditis was present in 27 patients, and prosthetic valve endocarditis was present in 13 patients. Abscesses were more frequent in aortic-valve endocarditis (57.5 percent) than in infections of other valves, and the infecting organism was more often Staphylococcus (42.5 percent of cases). The hospital mortality rate was 90 percent in the 10 patients who did not receive surgical treatment, as compared with 26.6 percent in the 30 operated-on patient (p < 0.001). Sensitivity and specificity for the detection of abscesses associated with endocarditis were 80.5 percent and 85 percent, respectively, for transthoracic two-dimensional echocardiography.


CONCLUSIONS
Our data indicate that transthoracic echocardiography remains an accurate method for the diagnosis of abscesses associated with endocarditis, even in the presence of a prosthetic valve, and it could help to indicate early surgery in these patients.
Aguado
J M
JM
Department of Internal Medicine, Hospital Nacional Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain.
González-Vílchez
F
F
Martín-Durán
R
R
Arjona
R
R
Vázquez de Prada
J A
JA
D000038:Abscess / Q000000981:diagnostic imaging* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D004452:Echocardiography; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000382:microbiology* / Q000473:pathology; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016037:Single-Blind Method; D013203:Staphylococcal Infections; D013290:Streptococcal Infections; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents