title: Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study.
abstract: BACKGROUND
  In patients with infective endocarditis (IE), detection of abscess remains difficult. We investigated abscess detection by transesophageal echocardiography (TEE) and predictors of abscess and death in patients with IE.
  
  
  METHODS
  A 5-year study included 115 patients with definite IE according to the modified Duke criteria who underwent TEE and cardiac surgery.
  
  
  RESULTS
  Abscess was found perioperatively in 44 patients (38%). Twenty-one abscesses (48%) were detected by TEE. Sixty-one percent of missed abscesses were localized on the posterior mitral annulus. In 64% of unrecognized mitral valve abscesses, the abscess was localized around calcification in the posterior mitral annulus. Fourteen patients (54%) had prosthetic valve dehiscence, and 8 (57%) had abscess as well. Overall 6-month mortality was 17% and predictable by age (odds ratio 1.1, 95% CI 1-1.001, P = .01), abscess (odds ratio 5.3, 95% CI 1.5-19, P = .01), and the causative microorganism (P = .035), in particular staphylococci. In patients with a missed abscess, surgical delay was significantly longer (P = .04) and mortality was nonsignificantly higher (P = .2) than in patients with a preoperatively detected abscess.
  
  
  CONCLUSIONS
  Detection of abscess by TEE seemed to be underestimated. In most cases, abscess was missed in the presence of calcification in the posterior mitral annulus. Age, abscess, and staphylococcal infection predicted 6-month mortality. Early surgery may improve outcome in patients with an abscess.
authors.affiliation: Department of Internal Medicine-Infectious Diseases, University Hospital Gasthuisberg KULEUVEN, Leuven, Belgium.
authors.forename: Evelyn E
authors.initials: EE
authors.lastname: Hill
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.forename: Piet
authors.initials: P
authors.lastname: Claus
authors.forename: Steven
authors.initials: S
authors.lastname: Vanderschueren
authors.forename: Willy E
authors.initials: WE
authors.lastname: Peetermans
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D000368:Aged; D017548:Echocardiography, Transesophageal / Q000379:methods*; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate