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Identification ofAbscess Formation in Native-Valve Infective Endocarditis using Transesophageal Echocardiography: Implications for Surgical Treatment S. Rehm ann . T. S eifert, R. Erbel, H. Jakob", S. Mohr-Kaha ly, T. Makowski, G. GOrge, H. Oelert", andJ.Meye r II. Medical Clinic * Division of Cardiothorac lc and Vascular Surgery , University ofMainz. FRG
Th e objec t of th e study was to follow pati en ts with en doca rditisassociated ab scess es in order to evalua te the clinical outcome with and without surgica l inte rve ntion. Tr an sesophageal echoca rdiogra phy su ccessfully displ ayed the locatio n and extent of abscess cavities in 14 patients (group Al with ao rt ic valve endocarditis. The infective process was limited to the perivalvul ar tissue in two. exte nde d int o th e asce nding ao rta in six. and included th e interve ntricula r se ptum, the right ventricular outflow tract. interat rial septum , an d/or mitra l valve a nnulus in six pat ien ts . The complication rate was significan tly higher in grou p A than in gro up B, which consist ed of 27 patients with proven signs of endoca rditis but without endocarditis-associated ab scesses. The compli cation rat es wer e embolic events 64 .3% in gro up A vs 29 .6% in group B, need for surgery in 64 .3% vs 18.5%, an d dea th in 50.0 % vs 3.7 %, respectively. The d ura tion of fever - as a marker of a n active infective pr ocess - before diagnosis an d the onset of adequate trea tmen t was significa ntly highe r in groupA than in group B (46 .7 ± 8.4 days vs 7.7 ± 2.6 da ys). Orga nism s wer e isolat ed in 71.4 % in groupA a nd in a ll pati en ts of grou p B. Stre ptococcal infections wer e noted in A in 54 .5% vs 44.4 % in B.. staphylococcal in 27.3% vs 40 .7 %. Initia l surgical rep air in 9 of 14 pati ents in A (64.3 %) included nine ao rtic valve an d one mitra l valve prost hesi s implanta tions , two aorti c valve-annulus reconstructive proc edures , one dacron patch closure, and three partial resections of the ao rta ascenden s with end-to-e nd a nas tomosis. Six pati ents (67.7 %) survived surgica l treatm ent. in contra st to only one of five (20 %) und ergoing medical tr eatment only. In groupB 18.5 % underwen t pla in valve replacement. which all pat ients survived; one patien t (3.7 %) who received med ical treat ment only died . Tr an sesophageal echocardiog ra phy allows a timely recognition of a bscess form a tion a nd progression a nd may permit ea rlier surgica l interventi on before widespre ad tissu e destruction occurs . Surge ry is then in a position to improve the outcome in patients with endoca rditis-a ssociated abscess es ; it de ma nds a diagnosis as ea rly as possible. because a delay in the onset of the ra py ma ndates more exte nsive su rgery with a higher risk than simpl e valve replacement.
Thorac. cardiovasc. Surgeon 39 ( 199 1) 273- 280 © Georg Thieme Verlag Stuttga rt New York
Er kennung von Abszessen be i tnrekuoser Endoka rditis mitt els tr an sbsoph agealer EchokardiographieChi rurgische FoIgerungen Gegenstand der Studie ist der klinische Verlauf von Patienten mit und ohne chiru rgisc he Interv ent ion bei infekti tiser Endokartitis
Identification ofAbscess Formation in Native-Valve Infective Endocarditis using Transesophageal Echocardiography: Implications for Surgical Treatment S. Rehm ann . T. S eifert, R. Erbel, H. Jakob", S. Mohr-Kaha ly, T. Makowski, G. GOrge, H. Oelert", andJ.Meye r II. Medical Clinic * Division of Cardiothorac lc and Vascular Surgery , University ofMainz. FRG
Th e objec t of th e study was to follow pati en ts with en doca rditisassociated ab scess es in order to evalua te the clinical outcome with and without surgica l inte rve ntion. Tr an sesophageal echoca rdiogra phy su ccessfully displ ayed the locatio n and extent of abscess cavities in 14 patients (group Al with ao rt ic valve endocarditis. The infective process was limited to the perivalvul ar tissue in two. exte nde d int o th e asce nding ao rta in six. and included th e interve ntricula r se ptum, the right ventricular outflow tract. interat rial septum , an d/or mitra l valve a nnulus in six pat ien ts . The complication rate was significan tly higher in grou p A than in gro up B, which consist ed of 27 patients with proven signs of endoca rditis but without endocarditis-associated ab scesses. The compli cation rat es wer e embolic events 64 .3% in gro up A vs 29 .6% in group B, need for surgery in 64 .3% vs 18.5%, an d dea th in 50.0 % vs 3.7 %, respectively. The d ura tion of fever - as a marker of a n active infective pr ocess - before diagnosis an d the onset of adequate trea tmen t was significa ntly highe r in groupA than in group B (46 .7 ± 8.4 days vs 7.7 ± 2.6 da ys). Orga nism s wer e isolat ed in 71.4 % in groupA a nd in a ll pati en ts of grou p B. Stre ptococcal infections wer e noted in A in 54 .5% vs 44.4 % in B.. staphylococcal in 27.3% vs 40 .7 %. Initia l surgical rep air in 9 of 14 pati ents in A (64.3 %) included nine ao rtic valve an d one mitra l valve prost hesi s implanta tions , two aorti c valve-annulus reconstructive proc edures , one dacron patch closure, and three partial resections of the ao rta ascenden s with end-to-e nd a nas tomosis. Six pati ents (67.7 %) survived surgica l treatm ent. in contra st to only one of five (20 %) und ergoing medical tr eatment only. In groupB 18.5 % underwen t pla in valve replacement. which all pat ients survived; one patien t (3.7 %) who received med ical treat ment only died . Tr an sesophageal echocardiog ra phy allows a timely recognition of a bscess form a tion a nd progression a nd may permit ea rlier surgica l interventi on before widespre ad tissu e destruction occurs . Surge ry is then in a position to improve the outcome in patients with endoca rditis-a ssociated abscess es ; it de ma nds a diagnosis as ea rly as possible. because a delay in the onset of the ra py ma ndates more exte nsive su rgery with a higher risk than simpl e valve replacement.
Thorac. cardiovasc. Surgeon 39 ( 199 1) 273- 280 © Georg Thieme Verlag Stuttga rt New York
Er kennung von Abszessen be i tnrekuoser Endoka rditis mitt els tr an sbsoph agealer EchokardiographieChi rurgische FoIgerungen Gegenstand der Studie ist der klinische Verlauf von Patienten mit und ohne chiru rgisc he Interv ent ion bei infekti tiser Endokartitis
