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Original ArticleOpen Access
Perivalvular Abscesses due to Staphylococcus aureus Endocarditis Comparison with Streptococcus viridans Endocarditis and Incremental Value of TransesophageaJ Echocardiography
Pachirat O 
,
Klungbaankrang V
,
Klungbaankrang V Background:
Peri valvular abscesses are major complications of infective endocarditis (IE).
The prevalence and best approach to detection of this complication in
Staphylococcus aureus
(SA)
in comparison to
Streptococcus viridans
(SV) IE is unclear.
Method:
Among 243 consecutive episodes of IE diagnosed using the Duke criteria, who
underwent either transthoracic (TIE) or transesophageal echocardiography (TEE) at the Mayo
Clinic between 1988 and 1993, there were 64 cases of SV and 61 of SA IE. Comparison of TTE
and TEE detection of abscesses were restricted to patients with either surgical or autopsy exami-
nation and both TTE and TEE were performed.
Results:
Prosthetic valve and valve repair were significantly higher in SA compared to
SV IE (46
vs
23%, P
=
0.008). The prevalence of abscesses was higher in SA compared to SV IE (42
vs
14%, P
=
0.08). I (10%) of abscess detected by TTE in SA compared to I (50%) in SV IE and
6 (60%) by TEE in SA and I (50%) in SV IE. Incremental value of TEE
vs
TIE was higher in SA
5/24 (21%) than in SV IE 0114 (0%) P
=
0.067. Hospital mortality was significantly higher in
SA than SV IE (13
vs
2%, P
=
0.013)
Conclusion:
Patients diagnosed with IE and those with SA I) presented more often with
prosthetic valve IE, 2) developed more perivalvular abscesses, and 3) had a higher in hospital
mortality than those with SV. Incremental value of TEE was higher in SA than in SV IE, 4) therefore,
had a stringent requirement for initial and repeated TEE to detect this ominous complication of
IE.
Key word
: Infective Endocarditis,
Staphylococcus aureus
Endocarditis,
Streptococcus viridans
Endocarditis, Transesophageal Echocardiography
Peri valvular abscesses are major complications of infective endocarditis (IE).
The prevalence and best approach to detection of this complication in
Staphylococcus aureus
(SA)
in comparison to
Streptococcus viridans
(SV) IE is unclear.
Method:
Among 243 consecutive episodes of IE diagnosed using the Duke criteria, who
underwent either transthoracic (TIE) or transesophageal echocardiography (TEE) at the Mayo
Clinic between 1988 and 1993, there were 64 cases of SV and 61 of SA IE. Comparison of TTE
and TEE detection of abscesses were restricted to patients with either surgical or autopsy exami-
nation and both TTE and TEE were performed.
Results:
Prosthetic valve and valve repair were significantly higher in SA compared to
SV IE (46
vs
23%, P
=
0.008). The prevalence of abscesses was higher in SA compared to SV IE (42
vs
14%, P
=
0.08). I (10%) of abscess detected by TTE in SA compared to I (50%) in SV IE and
6 (60%) by TEE in SA and I (50%) in SV IE. Incremental value of TEE
vs
TIE was higher in SA
5/24 (21%) than in SV IE 0114 (0%) P
=
0.067. Hospital mortality was significantly higher in
SA than SV IE (13
vs
2%, P
=
0.013)
Conclusion:
Patients diagnosed with IE and those with SA I) presented more often with
prosthetic valve IE, 2) developed more perivalvular abscesses, and 3) had a higher in hospital
mortality than those with SV. Incremental value of TEE was higher in SA than in SV IE, 4) therefore,
had a stringent requirement for initial and repeated TEE to detect this ominous complication of
IE.
Key word
: Infective Endocarditis,
Staphylococcus aureus
Endocarditis,
Streptococcus viridans
Endocarditis, Transesophageal Echocardiography
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