The role of transesophageal echocardiography in the diagnosis and management of patients with aortic perivalvular abscesses.
Aortic valve abscesses (AVAs) are a devastating complication of aortic valve endocarditis. Over 8 years, 25 patients were diagnosed with AVA by transesophageal echo (TEE). Management and outcomes were then analyzed. Eleven (44%) AVAs involved prosthetic valves, and 6 (24%) occurred in congenitally malformed valves. Twenty patients (80%) underwent surgical intervention; the rest were treated medically. Eleven (44%) of the patients died [6 (30%) surgery patients and all the medical patients]. Eight of 11 (73%) patients who died were culture positive for Staphylococcus aureus. All patients with congenitally malformed aortic valves underwent surgical intervention and survived. We conclude that: (1) despite advances in therapy and diagnosis, patients with AVAs have a high mortality rate; (2) prognosis with AVA is especially poor when S aureus is the infectious organism; (3) patients with AVAs in congenitally malformed valves have a great outcome with surgery; (4) patients treated medically have a very poor prognosis; earlier identification by TEE may be critical to improving survival.
Lerakis
S
S
Department of Medicine, Emory University School of Medicine and the Atlanta VA Medical Center, Georgia, USA.
Robert Taylor
W
W
Lynch
M
M
Litman
C M
CM
Clements
S D
SD
Thompson
T D
TD
Martin
R P
RP
D000038:Abscess / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001021:Aortic Valve / Q000002:abnormalities; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology / Q000401:mortality / Q000601:surgery; D002177:Candidiasis / Q000000981:diagnostic imaging; D003131:Combined Modality Therapy; D004198:Disease Susceptibility; D017548:Echocardiography, Transesophageal; D004617:Embolism / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D005260:Female; D006327:Heart Block / Q000209:etiology; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents