Korean Circ J.  2004 Sep;34(9):883-893. 10.4070/kcj.2004.34.9.883.

Clinical Characteristics of Subaortic Complications in Patients with Infective Endocarditis of the Aortic Valve

• Park DW
• Lee JH
• Kang SJ
• Song JM
• Kang DH
• Song JK
• Joo SJ
• Song H
• Lee JW
• Song MG

• KMID: 2297972
• DOI: http://doi.org/10.4070/kcj.2004.34.9.883

Abstract

BACKGROUND AND OBJECTIVE
Assessment of the clinical implications of subaortic complications, such as the involvement of the mitral-aortic intervalvular fibrosa (MAIVF) or anterior mitral valve leaflet (AMVL), were sought in patients with aortic valve infective endocarditis (AoIE). SUCJECTS AND METHODS: The clinical data of 95 consecutive (69 male) AoIE patients were retrospectively analyzed.
RESULTS
Subaortic complications were detected in 40 patients (42%). Involvement of the AMVL and MAIVF was present in 16 and 13 patients, respectively, and in 4 patients both were involved. The remaining 7 patients showed metastatic lesions in chordae or interventricular septum. Surgery was performed in 60 patients (63%, Group I) and the other 35 received medical treatment only;surgery was neither feasible due to multiorgan failure in 17 patients (Group II) nor necessary with stable hemodynamics in 18 (Group III). The overall in-hospital mortality was 19% (18/95), which was significantly different according to the treatment group (10% in group I, 65% in group II, and 6% in group III, p<0.001). In group I, patients with subaortic complications showed higher mortality compared to those without (22 vs. 0%, p=0.006). Surgery was performed in 28 patients with a periaortic abscess, and operative mortality was much higher in patients with a MAIVF abscess than in those with an abscess in other sites (40 vs. 0%, p=0.018). The sensitivity of transesophageal echocardiography for a subaortic complication was significantly higher than that of transthoracic echocardiography (89 vs. 41%, p<0.05).
CONCLUSION
Subaortic complications were relatively frequent in AoIE, and a MAIVF lesion is associated with a higher operative mortality.

Keyword

Endocarditis, bacterial; Subaortic complication; Echocardiography

MeSH Terms

Abscess
Aortic Valve*
Echocardiography
Echocardiography, Transesophageal
Endocarditis*
Endocarditis, Bacterial
Hemodynamics
Hospital Mortality
Humans
Mitral Valve
Mortality
Retrospective Studies