Valve ring abscess associated with infective endocarditis: echocardiographic features and clinical observations
Hwang, J.J.; Chang, T.H.; Tzou, S.S.; Feng, M.H.; Cheng, J.J.; Tseng, Y.Z.; Kuan, P.; Lien, W.P.
Journal of the Formosan Medical Association 92(2): 110-116
1993
ISSN/ISBN: 0929-6646 PMID: 8101737 Document Number: 415055
The presence of a valve ring abscess in patients with infective endocarditis adds appreciably to the expected rates of morbidity and mortality. From January 1989 to October 1991, a total of 43 consecutive patients with infective endocarditis seen at National Taiwan University Hospital were enrolled in this study. There were 30 men and 13 women, ranging in age from 14 to 75 years (mean +- SD 38.5 +- 15.0 years). The presence of infective endocarditis was documented by surgery in 26 patients and was based on a clinical diagnosis in the remaining 17 patients. A valve ring abscess was detected in five patients, either by transthoracic or transesophageal echocardiography, and all were confirmed at surgery. Aortic valve endocarditis was more frequently found in patients with valve ring abscesses (100% vs 31.6%, p lt 0.01), and the infecting organism was most often Staphylococcus aureus (60.0% vs 15.8%, p lt 0.05). The proportion of urgent operations was also higher in the group with abscesses (80.0% vs 23.7%, p lt 0.05). The hospital mortality was 40.0% in patients with abscesses and 5.3% in patients without abscesses, but the difference did not reach significance (p = 0.056). Transthoracic echocardiography identified valve ring abscesses in the first three patients, but transesophageal echocardiography was more useful in detecting abscesses located in the posterior aspect of the aortic root in the other two patients, in which the lesion was overlooked or only suspected by the transthoracic approach. It is concluded that: 1) the development of a valve ring abscess complicates infective endocarditis and leads to higher morbidity and mortality rates; 2) echocardiography is helpful in the diagnosis of a valve ring abscess and the transesophageal approach is superior to transthoracic echocardiography in the detection of abscesses located in the posterior aortic root; and 3) early recognition of a valve ring abscess is important in the clinical management of patients with infective endocarditis and may alter their outcome.