{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T18:54:11Z","timestamp":1783018451090,"version":"3.54.6"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T00:00:00Z","timestamp":1782950400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Mr. David Wright and Ms. Melanie Alder"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Data regarding mitral valve (MV) abscess, a severe complication of infective endocarditis, are limited. This study aimed to describe the clinical, microbiological, echocardiographic, and surgical characteristics of MV abscess.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a retrospective study of adults (\u226518 years) with MV abscess identified from the echocardiographic (October 2010\u2013August 2020) and cardiothoracic surgical databases (April 2002\u2013January 2020) at our centre. Data were obtained from electronic medical records. The primary endpoint was all-cause mortality. A total of 154 patients were included [median age 59 years, interquartile range (IQR): 47\u201368 years; 45% female], with a follow-up of 296 days (IQR: 6\u20131825 days). Native valves were affected in 69% of cases. Coagulase-negative Staphylococci (22%) were the most common pathogens, followed by Streptococci (20%), methicillin-resistant staphylococcus (16%), and methicillin-sensitive staphylococcus (14%). Surgery was performed in 146 patients, while 8 were managed conservatively. Bioprosthetic MV replacement was the common surgery (77%), and 27% required a Commando procedure. At surgery, MV abscess (64%) and abscess cavity (32%) were the predominant findings. Surgical classification specified the location and extension of the abscess, with posteromedial annulus being most commonly involved (64%). Mortality was 10% at 30 days, 33% at 1 year, and 71% during the entire follow-up period, without significant differences between native and prosthetic valve groups (P = 0.116).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MV abscess is a highly morbid condition. Detailed surgical classification supports operative planning and assessment of disease extent. Despite high rates of complex surgery, mortality remains substantial, underscoring the aggressive nature of this condition.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyag112","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T12:39:24Z","timestamp":1781613564000},"source":"Crossref","is-referenced-by-count":0,"title":["Mitral valve abscess: echocardiographic imaging, microbiology, management, and outcomes"],"prefix":"10.1093","volume":"4","author":[{"given":"Krishna O","family":"Sanaka","sequence":"first","affiliation":[{"name":"Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00f6sta B","family":"Pettersson","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6844-073X","authenticated-orcid":false,"given":"Shinya","family":"Unai","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4089-2202","authenticated-orcid":false,"given":"Jos\u00e9","family":"Navia","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Florida , Weston, FL 33331 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E","family":"Roselli","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marijan","family":"Koprivanac","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Marc","family":"Gillinov","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Witten","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Sydell and Arnold Miller Family Heart, Vascular, and Thoracic Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Integrated Hospital-Care Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nabin K","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease, Integrated Hospital-Care Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Austin","family":"Firth","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic , Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Al Zein","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard A","family":"Grimm","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P","family":"Griffin","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2985-7468","authenticated-orcid":false,"given":"Bo","family":"Xu","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Desk J1-5, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,2]]},"reference":[{"key":"2026070213425319300_qyag112-B1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/S0140-6736(24)01098-5","article-title":"Infective endocarditis","volume":"404","author":"Li","year":"2024","journal-title":"The Lancet"},{"key":"2026070213425319300_qyag112-B2","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1016\/j.ahj.2007.06.028","article-title":"Abscess in infective endocarditis: the value of transesophageal echocardiography and outcome: a 5-year study","volume":"154","author":"Hill","year":"2007","journal-title":"Am Heart J"},{"key":"2026070213425319300_qyag112-B3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.ejcts.2006.10.036","article-title":"Surgical treatment of paravalvular abscess: long-term results","volume":"31","author":"David","year":"2007","journal-title":"Eur J Cardio-Thorac Surg"},{"key":"2026070213425319300_qyag112-B4","first-page":"yty003","article-title":"Ruptured mitral valve abscess with mitral incompetence in culture negative infective endocarditis: case report","volume":"2","author":"Dashti","year":"2018","journal-title":"Eur Heart J Case Rep"},{"key":"2026070213425319300_qyag112-B5","doi-asserted-by":"crossref","first-page":"ytac010","DOI":"10.1093\/ehjcr\/ytac010","article-title":"Cardiac pseudoaneurysm as a complication of native mitral valve infective endocarditis","volume":"6","author":"Khan","year":"2022","journal-title":"Eur Heart J Case Rep"},{"key":"2026070213425319300_qyag112-B6","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1016\/j.repc.2020.06.023","article-title":"Native mitral valve endocarditis complicated with abscess and fistulas: diagnosis by three-dimensional transesophageal echocardiography","volume":"40","author":"Gabald\u00f3n-P\u00e9rez","year":"2021","journal-title":"Rev Port Cardiol"},{"key":"2026070213425319300_qyag112-B7","first-page":"1742.e9","article-title":"Posterior mitral abscess with bypass grafting before annulus reconstruction: a case report","volume":"29","author":"Une","year":"2013","journal-title":"Can J Cardiol"},{"key":"2026070213425319300_qyag112-B8","first-page":"e35","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"2026070213425319300_qyag112-B9","doi-asserted-by":"crossref","first-page":"630","DOI":"10.21037\/acs.2019.10.05","article-title":"Current AATS guidelines on surgical treatment of infective endocarditis","volume":"8","author":"Pettersson","year":"2019","journal-title":"Ann Cardiothorac Surg"},{"key":"2026070213425319300_qyag112-B10","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.xjtc.2021.10.043","article-title":"Commentary: multivalve infective endocarditis: further support for radical debridement and complex reconstruction","volume":"10","author":"Girardi","year":"2021","journal-title":"JTCVS Tech"},{"key":"2026070213425319300_qyag112-B11","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S0003-4975(00)02334-1","article-title":"Acute endocarditis treated with radical debridement and implantation of mechanical or stented bioprosthetic devices","volume":"71","author":"Aagaard","year":"2001","journal-title":"Ann Thorac Surg"},{"key":"2026070213425319300_qyag112-B12","doi-asserted-by":"crossref","first-page":"3948","DOI":"10.1093\/eurheartj\/ehad193","article-title":"2023 ESC guidelines for the management of endocarditis: developed by the task force on the management of endocarditis of the European Society of Cardiology (ESC) endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and the European Association of Nuclear Medicine (EANM)","volume":"44","author":"Delgado","year":"2023","journal-title":"Eur Heart J"},{"key":"2026070213425319300_qyag112-B13","doi-asserted-by":"crossref","first-page":"964","DOI":"10.4070\/kcj.2018.0308","article-title":"Early surgery in valvular heart disease","volume":"48","author":"Kim","year":"2018","journal-title":"Korean Circ J"},{"key":"2026070213425319300_qyag112-B14","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.ejim.2020.04.017","article-title":"Embolic risk stratification and prognostic impact of early surgery in left-sided infective endocarditis","volume":"78","author":"Scheggi","year":"2020","journal-title":"Eur J Intern Med"},{"key":"2026070213425319300_qyag112-B15","doi-asserted-by":"crossref","first-page":"254","DOI":"10.4330\/wjc.v13.i8.254","article-title":"Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: a contemporary narrative review","volume":"13","author":"Lo Presti","year":"2021","journal-title":"World J Cardiol"},{"key":"2026070213425319300_qyag112-B16","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4103\/jcecho.jcecho_53_19","article-title":"Infective endocarditis: echocardiographic imaging and new imaging modalities","volume":"29","author":"Sordelli","year":"2019","journal-title":"J Cardiovasc Echography"},{"key":"2026070213425319300_qyag112-B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcad.2023.10.007","article-title":"Role of multimodality imaging in infective endocarditis: contemporary diagnostic and prognostic considerations","author":"Xu","year":"2023","journal-title":"Prog Cardiovasc Dis"},{"key":"2026070213425319300_qyag112-B18","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.echo.2017.01.007","article-title":"Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American society of echocardiography developed in collaboration with the society for cardiovascular magnetic resonance","volume":"30","author":"Zoghbi","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2026070213425319300_qyag112-B19","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1016\/j.echo.2013.07.009","article-title":"Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American society of echocardiography and the society of cardiovascular anesthesiologists","volume":"26","author":"Hahn","year":"2013","journal-title":"J Am Soc Echocardiogr"},{"key":"2026070213425319300_qyag112-B20","doi-asserted-by":"crossref","first-page":"257","DOI":"10.21037\/cdt-22-431","article-title":"Diagnostic performance of contemporary transesophageal echocardiography with modern imaging for infective endocarditis","volume":"13","author":"Montan\u00e9","year":"2023","journal-title":"Cardiovasc Diagn Ther"},{"key":"2026070213425319300_qyag112-B21","doi-asserted-by":"crossref","first-page":"e010600","DOI":"10.1161\/CIRCIMAGING.120.010600","article-title":"Diagnosis of infective endocarditis by subtype using 18F-fluorodeoxyglucose positron emission tomography\/computed tomography: a contemporary meta-analysis","volume":"13","author":"Wang","year":"2020","journal-title":"Circ Cardiovasc Imaging"},{"key":"2026070213425319300_qyag112-B22","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.tcm.2024.04.005","article-title":"Role of multimodality imaging in infective endocarditis: a comparison of the major society guidelines in the United States and Europe","volume":"35","author":"Vinod","year":"2025","journal-title":"Trends Cardiovasc Med"},{"key":"2026070213425319300_qyag112-B23","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jcct.2020.11.008","article-title":"Diagnostic performance of cardiac computed tomography versus transesophageal echocardiography in infective endocarditis: a contemporary comparative meta-analysis","volume":"15","author":"Jain","year":"2021","journal-title":"J Cardiovasc Comput Tomogr"},{"key":"2026070213425319300_qyag112-B24","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.bjid.2013.02.010","article-title":"Methicillin-resistant and methicillin-susceptible community-acquired Staphylococcus aureus infection among children","volume":"17","author":"Gomes","year":"2013","journal-title":"Braz J Infect Dis"},{"key":"2026070213425319300_qyag112-B25","doi-asserted-by":"crossref","first-page":"275","DOI":"10.4103\/0255-0857.188313","article-title":"The changing face of community-acquired methicillin-resistant Staphylococcus aureus","volume":"34","author":"Kale","year":"2016","journal-title":"Indian J Med Microbiol"},{"key":"2026070213425319300_qyag112-B26","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/joim.13491","article-title":"Microbiological etiology in prosthetic valve endocarditis: a nationwide registry study","volume":"292","author":"Berisha","year":"2022","journal-title":"J Intern Med"},{"key":"2026070213425319300_qyag112-B27","doi-asserted-by":"crossref","first-page":"e0290998","DOI":"10.1371\/journal.pone.0290998","article-title":"Clinical presentation, microbiology, and prognostic factors of prosthetic valve endocarditis. Lessons learned from a large prospective registry","volume":"18","author":"Ramos-Mart\u00ednez","year":"2023","journal-title":"PLoS One"},{"key":"2026070213425319300_qyag112-B28","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1093\/cid\/ciab1004","article-title":"Perivalvular extension of infective endocarditis after transcatheter aortic valve replacement","volume":"75","author":"Panagides","year":"2022","journal-title":"Clin Infect Dis"},{"key":"2026070213425319300_qyag112-B29","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.cmi.2020.09.003","article-title":"Factors associated with local invasion in infective endocarditis: a nested case-control study","volume":"27","author":"Ramanathan","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2026070213425319300_qyag112-B30","first-page":"44","article-title":"Clinical features and mortality rate of infective endocarditis in intensive care unit: a large-scale study and literature review","volume":"28","author":"Cresti","year":"2024","journal-title":"Anatol J Cardiol"},{"key":"2026070213425319300_qyag112-B31","doi-asserted-by":"crossref","first-page":"e026811","DOI":"10.1136\/bmjopen-2018-026811","article-title":"Trends in occurrence and 30-day mortality of infective endocarditis in adults: population-based registry study in Finland","volume":"9","author":"Ahtela","year":"2019","journal-title":"BMJ Open"},{"key":"2026070213425319300_qyag112-B32","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1007\/s10554-024-03088-w","article-title":"Intramyocardial abscess and endoventricular thrombosis: a complex case","volume":"40","author":"Rodella","year":"2024","journal-title":"Int J Cardiovasc Imaging"},{"key":"2026070213425319300_qyag112-B33","first-page":"513","article-title":"Multidisciplinary perspectives of challenges in infective endocarditis complicated by septic embolic-induced acute myocardial infarction","volume":"13","author":"Stamate","year":"2024","journal-title":"Antibiot Basel Switz"},{"key":"2026070213425319300_qyag112-B34","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.repc.2021.02.027","article-title":"Infective endocarditis: epidemiology and prognosis","volume":"41","author":"Apolin\u00e1rio","year":"2022","journal-title":"Rev Port Cardiol"},{"key":"2026070213425319300_qyag112-B35","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1007\/s15010-019-01338-x","article-title":"Prognostic factors of mortality after surgery in infective endocarditis: systematic review and meta-analysis","volume":"47","author":"Varela Barca","year":"2019","journal-title":"Infection"}],"container-title":["European Heart Journal - Imaging Methods and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/3\/qyag112\/68684325\/qyag112.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/4\/3\/qyag112\/68684325\/qyag112.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T17:47:08Z","timestamp":1783014428000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjimp\/article\/doi\/10.1093\/ehjimp\/qyag112\/8723773"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,2]]},"references-count":35,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjimp\/qyag112","relation":{},"ISSN":["2755-9637"],"issn-type":[{"value":"2755-9637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,2]]},"article-number":"qyag112"}}