Background
Perivalvular abscess (PVA) is a known complication of endocarditis which worsens prognosis and is an indication for surgery. Early diagnosis of PVA is vital for patient management. Transesophageal echocardiography (TEE) is the current gold standard for the diagnosis of PVA, however limited data are available regarding the sensitivity of TEE, particularly on native mitral valves. The objective of this study was to determine the sensitivity of TEE for the detection of perivalvular abscess in patients with native mitral valve endocarditis.
Methods
We reviewed the institutional database for patients who were diagnosed with native mitral valve endocarditis who underwent TEE and surgical intervention. We then compared the rates of abscess detection on TEE to the findings at the time of surgery.
Results
37 patients (mean age 59.4 years, M/F 22/15) were diagnosed with native mitral valve endocarditis between the years 2009-2015, of whom 11 underwent surgery. A perivalvular abscess was found in 6 of the 11 patients who underwent surgery. Only 3 of these patients had PVA diagnosed on TEE prior to surgery (sensitivity 50%). The 5 patients who were operated on and were not found to have an abscess were all correctly identified by TEE (specificity 100%).
Conclusions
TEE had a limited sensitivity of 50% for the detection of native mitral PVA. Given the increased mortality in patients with PVA and the importance of early surgery, other imaging modalities in addition to TEE may need to be considered in cases of native mitral valve endocarditis.
