Two-dimensional echocardiographic recognition of aortic valve ring abscess.

2D-echocardiography was performed in 42 consecutive patients with suspected aortic endocarditis who subsequently underwent surgery. On surgery, 12 patients had perivalvular aortic abscesses: in the posterior part of the ring (7) with extension to the aorto-mitral fibrous trigone or pseudo-aneurysm of the aortic wall; in the anterior part of the ring (3), with extension toward the interventricular septum; or with near complete aorto-left ventricular disruption (2). Perivalvular abscess was seen on 2D-echo in 8 patients: echo-free cavity located in the aortic ring, beyond the sigmoid valvulae and sometimes containing necrotic material. In 4 patients, the abscess was not diagnosed on 2D-echo; 2 had small, localized abscesses but the remaining 2 had large abscesses developed around previously implanted mechanical prostheses, which considerably impeded echographic examination. One additional patient with acute aortic regurgitation and fever had an image of posterior abscess, but on surgery, the posterior wall of the aorta appeared inflammatory and oedematous without perivalvular abscess. Accurate topographic diagnosis was made in 6 of the 8 patients, while in 2 the abscess was located more to the left than considered on 2D-echo. Generally, 2D-echo tended to underestimate the importance and extension of the lesions. It is concluded that 2D-echo is helpful to diagnose perivalvular aortic infection.