Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients

Analysis of 95 necropsy patients with active infective endocarditis (AIE) involving 128 native cardiac valves (aortic = 59, mitral = 48, triscupid = 20, and pulmonic = 1) disclosed 27 patients with ring abscesses involving 30 valves: the aortic valve ring was infected in 24 patients and only an atrioventricular valve ring (mitral in two, and tricuspid in one) in three patients. Comparison of the following parameters showed no significant differences between the 27 patients with and the 68 patients without ring abscess: age, sex, antibiotic treatment or length of treatment, status of the cardiac valve(s) before infection, and the kind of infecting organism. Comparison of the following parameters, however, showed significant (p<0.05) differences between the 27 patients with and the 68 patients without valve ring abscess: infection of the aortic valve; occurrence of valvular regurgitation of recent origin; presence of pericarditis; presence of high degree of atrioventricular block; short duration of symptoms leading to severe debility or death. These 5 features, therefore, serve as clinical clues to the presence of valve ring abscess in patients with AIE.