Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography.
BACKGROUND
Paravalvular abscess is a complication of endocarditis that may lead to persistent infection, conduction abnormalities, fistula formation, worsening congestive heart failure, and death.


METHODS
Between 1991 and 2001, paravalvular abscess was identified on transesophageal echocardiography in 24 patients who subsequently underwent surgical treatment. Echocardiographic findings were reviewed for location of abscess, presence of a valvular prosthesis, valvular function, and presence of vegetations. Information gathered included the time interval between transesophageal echocardiography diagnosis and operation, inhospital mortality, and microbiologic data.


RESULTS
Of 24 patients, 9 died, for a mortality of 38%. Of the patients who died, the average survival after operation was 43 days, with a range of 1 to 238 days. Of the 14 patients with significant valvular or paravalvular regurgitation, 8 died (57%). However, of the 10 patients with mild or no regurgitation, only 1 died (10%). This difference was statistically significant (P =.02).


CONCLUSIONS
Patients without preserved valve function (those with moderate or severe regurgitation) have a significantly worse outcome (57% mortality) than do those with normal valvular function (10% mortality).
Cosmi
John E
JE
New York University School of Medicine, New York, NY 10016, USA.
Tunick
Paul A
PA
Kronzon
Itzhak
I
D000038:Abscess / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal / Q000379:methods; D004697:Endocarditis, Bacterial / Q000150:complications*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging