PERIVALVULAR CAVITIES IN ENDOCARDITIS - ABSCESSES VERSUS PSEUDOANEURYSMS - A TRANSESOPHAGEAL DOPPLER-ECHOCARDIOGRAPHIC STUDY IN 118 PATIENTS WITH ENDOCARDITIS

The appearance of perivalvular cavities (PCs) in patients with infecti ous endocarditis (IE) was studied by transesophageal echocardiography (TEE) color Doppler examinations to determine whether the color Dopple r TEE presentation was in keeping with the current concept of PCs repr esenting abscesses. Two heart centers participated in the study. Video tape recordings of TEE examinations in patients with IE were analyzed retrospectively for 18 months in both centers, and one center included patients prospectively for an additional 18 months. A total of 118 pa tients with a diagnosis sis of IE based on TEE and clinical and labora tory findings Range were seen during the study period. TEE showed PCs in 34 patients. In 3 patients who died, no autopsy was performed; the PCs were proved at autopsy or surgery in the remaining 31 patients, wh o constituted the study population. All PCs were echo free at TEE. Apa rt from one technically inadequate examination, all PCs contained colo r Doppler signals indicating intracavitary blood flow; the PCs communi cated through a narrow channel with high-pressure regions (the left ve ntricle or the ascending aorta). At surgery or autopsy, only 2 of the 31 patients had pus accumulations besides the blood-filled PCs. At TEE the pus accumulations presented as echo-rich, shaggy tissue thickenin g. It is concluded that well-delineated, echo-free PCs with intracavit ary color Doppier signals at TEE appear to be pseudoaneurysms, and the refore the term abscess should not be used in these cases. Although fu rther studies are needed, our findings suggest that PCs more likely oc cur by infectious tissue weakening and subsequent dissection rather th an as a result of primary abscess formation with secondary rupture. PC s are nevertheless a result of severe IE, and an aggressive surgical a pproach is still recommended.