Clinical Characteristics of Subaortic Complications in Patients with Infective Endocarditis of the Aortic Valve.
10.4070/kcj.2004.34.9.883
- Author:
Duk Woo PARK
1
;
Jae Hwan LEE
;
Soo Jin KANG
;
Jong Min SONG
;
Duk Hyun KANG
;
Jae Kwan SONG
;
Suk Jung JOO
;
Hyun SONG
;
Jae Won LEE
;
Meong Gun SONG
Author Information
1. Divisions of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jksong@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Endocarditis, bacterial;
Subaortic complication;
Echocardiography
- MeSH:
Abscess;
Aortic Valve*;
Echocardiography;
Echocardiography, Transesophageal;
Endocarditis*;
Endocarditis, Bacterial;
Hemodynamics;
Hospital Mortality;
Humans;
Mitral Valve;
Mortality;
Retrospective Studies
- From:Korean Circulation Journal
2004;34(9):883-893
- CountryRepublic of Korea
- Language:Korean
-
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.
