The role of transesophageal echocardiography in the diagnosis and management of patients with aortic perivalvular abscesses

Aortic valve abscesses (AVAs) are a devastating complication of aortic valv e endocarditis. Over 8 years, 25 patients were diagnosed with AVA by transe sophageal echo (TEE). Management and outcomes were then analyzed. Eleven (4 4%) AVAs involved prosthetic valves, and 6 (24%) occurred in congenitally m alformed valves. Twenty patients (80%) underwent surgical intervention; the rest were treated medically. Eleven (44%) of the patients died [6 (30%) su rgery patients and all the medical patients]. Eight of 11 (73%) patients wh o died were culture positive for Staphylococcus aureus. All patients with c ongenitally malformed aortic valves underwent surgical intervention and sur vived. We conclude that: (1) despite advances in therapy and diagnosis, pat ients with AVAs have a high mortality rate; (2) prognosis with AVA is espec ially poor when S aureus is the infectious organism; (3) patients with AVAs in congenitally malformed valves have a great outcome with surgery; (4) pa tients treated medically have a very poor prognosis; earlier identification by TEE may be critical to improving survival.