Mortality in patients with paravalvular abscess diagnosed by transesophageal echocardiography.

BACKGROUND: Paravalvular abscess is a complication of endocarditis that may lead to persistent infection, conduction abnormalities, fistula formation, worsening congestive heart failure, and death.

METHODS: Between 1991 and 2001, paravalvular abscess was identified on transesophageal echocardiography in 24 patients who subsequently underwent surgical treatment. Echocardiographic findings were reviewed for location of abscess, presence of a valvular prosthesis, valvular function, and presence of vegetations. Information gathered included the time interval between transesophageal echocardiography diagnosis and operation, inhospital mortality, and microbiologic data.

RESULTS: Of 24 patients, 9 died, for a mortality of 38%. Of the patients who died, the average survival after operation was 43 days, with a range of 1 to 238 days. Of the 14 patients with significant valvular or paravalvular regurgitation, 8 died (57%). However, of the 10 patients with mild or no regurgitation, only 1 died (10%). This difference was statistically significant (P =.02).

CONCLUSION: Patients without preserved valve function (those with moderate or severe regurgitation) have a significantly worse outcome (57% mortality) than do those with normal valvular function (10% mortality).