PERIVALVULAR ABSCESSES ASSOCIATED WITH ENDOCARDITIS - CLINICAL-FEATURES AND DIAGNOSTIC-ACCURACY OF 2-DIMENSIONAL ECHOCARDIOGRAPHY

Objective: To determine the clinical implications of the development o f a perivalvular abscess in the course of an infective endocarditis an d evaluate the utility of two-dimensional echocardiography in the diag nosis of this complication. Design: Retrospective clinical review. Inv estigator-blinded comparative echographic case-control study. Setting: Tertiary referral center. Patients: Forty patients with infective end ocarditis and a histologically proved diagnosis of perivalvular absces s. Intervention: Two-dimensional echocardiograms corresponding to 36 o f these 40 patients were blindly compared with two-dimensional echocar diograms of 20 randomly chosen patients with infective endocarditis in whom myocardial abscesses had not been demonstrated during surgery. M easurements and main results: During surgery or at autopsy, 40 patient s had a total of 41 definite perivalvular abscesses. Native valve endo carditis was present in 27 patients, and prosthetic valve endocarditis was present in 15 patients. Abscesses were more frequent in aortic-va lve endocarditis (57.5 percent) than in infections of other valves, an d the infecting organism was more often Staphylococcus (42.5 percent o f cases). The hospital mortality rate was 90 percent in the 10 patient s who did not receive surgical treatment, as compared with 26.6 percen t in the 30 operated-on patients (p<0.001). Sensitivity and specificit y for the detection of abscesses associated with endocarditis were 80. 5 percent and 85 percent, respectively, for transthoracic two-dimensio nal echocardiography. Conclusions: Our data indicate that transthoraci c echocardiography remains an accurate method for the diagnosis of abs cesses associated with endocarditis, even in the presence of a prosthe tic valve, and it could help to indicate early surgery in these patien ts.