Echocardiographic detection of aortic valve ring abscesses.

Valve ring abscess complication of infective endocarditis increases the expected morbidity and mortality rates of patients, but is seldom recognized by available noninvasive techniques. In our study, two-dimensional echocardiography successfully detected valve ring abscesses in eight patients with infective endocarditis affecting aortic valve prosthesis. Echocardiography showed the perivalvular abscess as an echo-free space in all patients. Prosthetic vegetations were seen in the only patient who had a biological prosthesis and excessive prosthetic rocking was observed in cases with severe aortic regurgitation. In two patients, the first echocardiographic examination showed an echo-free space without evident clinical signs of endocarditis or significant valve regurgitation. Severe aortic insufficiency and congestive heart failure followed the enlargement of the echo-free space. Valve replacement was required in all but one patient. The echocardiographic findings were confirmed at surgery. In one patient, the extension of the abscess to the interventricular septum was not detected by the echocardiography.