Korean Circ J.  2011 Aug;41(8):482-485. 10.4070/kcj.2011.41.8.482.

A Case of Staphylococcal Tricuspid Valve Endocarditis With Para-Aortic Abscess in a Patient With Bicuspid Aortic Valve

  • 1Department of Internal Medicine, Mokdong Hospital, School of Medicine, Ewha Womans University, Seoul, Korea. pseongh@ewha.ac.kr


Paravalvular abscess is a serious complication of infective endocarditis. The aortic valve and its adjacent ring are more susceptible to abscess formation and paravalvular extension than the mitral valve. A 15-years old patient with bicuspid aortic valve presented with staphylococcal tricuspid valve endocarditis complicated by para-aortic abscess that ruptured into the aortic sinus. We report the clinical, laboratory and echocardiographic features and treatment of this patient and conduct a literature review on this subject.


Endocarditis; Abscess

MeSH Terms

Aortic Valve
Heart Valve Diseases
Mitral Valve
Sinus of Valsalva
Tricuspid Valve
Aortic Valve
Heart Valve Diseases


  • Fig. 1 Short-axis view of the aortic valve on transthoracic echocardiography. A: a mobile vegetation (arrow) is noted at the base of septal leaflet of tricuspid valve. B: a large abscess cavity (arrow) communicating with the aortic sinus is seen in the para-aortic area.

  • Fig. 2 Transesophageal echocardiography showed a bicuspid aortic valve with a large para-aortic abscess (1.6×2.1 cm) with direct communication to aortic sinus. A: the right side commissure of the bicuspid aortic valve is ruptured. B: color flow into the abscess cavity is visualized well during diastole.


1. Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, clues to clinical diagnosis from the study of 95 necropsy patients. Circulation. 1976. 54:140–145.
2. Chan KL. Early clinical course and long-term outcome of patients with infective endocarditis complicated by perivalvular abscess. CMAJ. 2002. 167:19–24.
3. Ellis SG, Goldstein J, Popp RL. Detection of endocarditis-associated perivalvular abscesses by two-dimensional echocardiography. J Am Coll Cardiol. 1985. 5:647–653.
4. Jault F, Gandjbakhch I, Chastre JC, et al. Prosthetic valve endocarditis with ring abscesses: surgical management and long-term results. J Thorac Cardiovasc Surg. 1993. 105:1106–1113.
5. Pansini S, di Summa M, Patane F, Forsennati PG, Serra M, Del Ponte S. Risk of recurrence after reoperation for prosthetic valve endocarditis. J Heart Valve Dis. 1997. 6:84–87.
6. Croft CH, Woodward W, Elliott A, Commerford PJ, Barnard CN, Beck W. Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis. Am J Cardiol. 1983. 51:1650–1655.
7. Mullany CJ, Chua YL, Schaff HV, et al. Early and late survival after surgical treatment of culture-positive active endocarditis. Mayo Clin Proc. 1995. 70:517–525.
8. Choussat R, Thomas D, Isnard R, et al. Perivalvular abscesses associated with endocarditis: clinical features and prognostic factors of overall survival in a series of 233 cases. Eur Heart J. 1999. 20:232–241.
9. Muller LC, Chevtchik O, Bonatti JO, Muller S, Fille M, Laufer G. Treatment of destructive aortic valve endocarditis with the Freestyle Aortic Root Bioprosthesis. Ann Thorac Surg. 2003. 75:453–456.
10. Yankah AC, Klose H, Petzina R, Musci M, Siniawski H, Hetzer R. Surgical management of acute aortic root endocarditis with viable homograft: 13-year experience. Eur J Cardiothorac Surg. 2002. 21:260–267.
11. Kunis RL, Sherrid MV, McCabe JB, Grieco MH, Dwyer EM Jr. Successful medical therapy of mitral annular abscess complicating infective endocarditis. J Am Coll Cardiol. 1986. 7:953–955.
12. Park DW, Lee JH, Kang SJ, et al. Clinical characteristics of subaortic complications in patients with infective endocarditis of the aortic valve. Korean Circ J. 2004. 34:883–893.
13. Scanlan JG, Seward JB, Tajik AJ. Valve ring abscess in infective endocarditis: visualization with wide angle two dimensional echocardiography. Am J Cardiol. 1982. 49:1794–1800.
14. Tucker KJ, Johnson JA, Ong T, Mullen WL, Mailhot J. Medical management of prosthetic aortic valve endocarditis and aortic root abscess. Am Heart J. 1993. 125:1195–1197.
15. Byrd BF 3rd, Shelton ME, Wilson BH 3rd, Schillig S. Infective perivalvular abscess of the aortic ring: echocardiographic features and clinical course. Am J Cardiol. 1990. 66:102–105.
16. Sande MA, Courtney KB. Nafcillin-gentamicin synergism in experimental staphylococcal endocarditis. J Lab Clin Med. 1976. 88:118–124.
17. Jeang MK, Fuentes F, Gately A, Byrnes J, Lewis M. Aortic root abscess: initial experience using magnetic resonance imaging. Chest. 1986. 89:613–615.
18. Sande MA, Johnson ML. Antimicrobial therapy of experimental endocarditis caused by Staphylococcus aureus. J Infect Dis. 1975. 131:367–375.
19. Sande MA, Courtney KB. Nafcillin-gentamicin synergism in experimental staphylococcal endocarditis. J Lab Clin Med. 1976. 88:118–124.
20. Cha R, Brown WJ, Rybak MJ. Bactericidal activities of daptomycin, quinupristin-dalfopristin, and linezolid against vancomycin-resistant Staphylococcus aureus in an in vitro pharmacodynamic model with simulated endocardial vegetations. Antimicrob Agents Chemother. 2003. 47:3960–3963.
Full Text Links
  • KCJ
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr