Myocardial Abscess Follow-up

  • Author: Vibhuti N Singh, MD, MPH, FACC, FSCAI; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Jan 11, 2012
 

Further Inpatient Care

  • Aggressive postoperative supportive therapy in patients with myocardial abscess includes the following:
    • Agents for stabilization of hemodynamics
    • Fluid and electrolyte balance
    • Nutrition (parenteral or enteral)
  • Continuation of antibiotic therapy may be necessary. Patients may still require a prolonged 6-week course of antibiotic therapy.
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Further Outpatient Care

  • Continuation of adjunctive therapy
  • Anticoagulation therapy, in case of metallic prosthetic valve replacement
  • Continuing antibiotic therapy
  • Diuretic use with CHF
  • Antiarrhythmic therapy for postoperative arrhythmias
  • Aggressive antibiotic prophylaxis prior to minor surgeries
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Inpatient & Outpatient Medications

  • Vancomycin
  • Gentamicin
  • Dopamine
  • Diuretics
  • Anticoagulants
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Transfer

  • Patients with infective endocarditis usually exhibit rapid deterioration, and they may require transfer to a tertiary care facility for a diagnostic workup and open heart surgery. Such patients must be transported via an Advanced Cardiac Life Support ambulance staffed with well-trained and experienced paramedics.
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Deterrence/Prevention

  • Prompt and effective treatment of infective endocarditis is required.
  • A high index of suspicion and early recognition of the changes that suggest development of myocardial abscess are necessary.
  • Regular prophylaxis for subacute bacterial endocarditis, with preoperative antibiotics according to the recommendations of the American Heart Association, is necessary.
  • Critically ill patients with myocardial abscess and infective endocarditis are usually bedridden, with minimal activity. Frequently, such patients must receive prophylaxis to prevent development of DVT and PE.
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Complications

  • Myocardial perforation
  • Significant clinical deterioration
  • Worsening CHF
  • Worsening heart sounds and murmurs
  • New-onset valvular regurgitation (100% of cases)[11]
  • Poor response to antibiotics
  • Development of conduction defects or progression of heart block, such as bundle-branch block and atrioventricular block (45%)[2]
  • Sudden onset of complete heart block or Mobitz type II block (highly specific)
  • Type of valve involvement, eg, aortic valve endocarditis (40%-85%)
  • Miscellaneous
    • Severe recurrent ventricular arrhythmias
    • Pericarditis (uncommon)
    • Infection of the prosthetic valves
    • Right-sided endocarditis in patients with congenital heart disease
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Prognosis

  • With early diagnosis and prompt surgical treatment, patients improve rapidly.
  • Without surgical intervention, the prognosis worsens very significantly.
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Patient Education

  • Educate patients regarding their condition, and emphasize the importance of prophylaxis.
  • For excellent patient education resources, visit eMedicine's Infections Center and Heart Center. Also, see eMedicine's patient education articles Abscess and Antibiotics.
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Contributor Information and Disclosures
Author

Vibhuti N Singh, MD, MPH, FACC, FSCAI  Director, Suncoast Cardiovascular Center; Chair, Cardiology Division and Cath Labs, Department of Medicine, Bayfront Medical Center; Clinical Assistant Professor, Division of Cardiology, University of South Florida College of Medicine

Vibhuti N Singh, MD, MPH, FACC, FSCAI is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Florida Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Kul Aggarwal, MD, FACC  Professor of Clinical Medicine, Department of Internal Medicine, Division of Cardiology, University of Missouri-Columbia School of Medicine; Chief, Cardiology Section, Harry S Truman Veterans Hospital

Kul Aggarwal, MD, FACC is a member of the following medical societies: American College of Cardiology and American College of Physicians

Disclosure: Nothing to disclose.

Rakesh K Sharma, MD, FACC  Adjunct Associate Professor of Medicine and Cardiology; University of Arkansas for Medical Sciences, Medical Center of South Arkansas

Rakesh K Sharma, MD, FACC is a member of the following medical societies: American College of Cardiology, American College of International Physicians, American College of Physicians, American Heart Association, and American Medical Association

Disclosure: Nothing to disclose.

Jamshid Shirani, MD  Director of Cardiology Fellowship Program, Director of Echocardiography Laboratory, St Luke's Hospital and Health Network

Jamshid Shirani, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Echocardiography, and Association of Subspecialty Professors

Disclosure: Nothing to disclose.

Joel A Strom, MD, ME  Adjunct Clinical Professor of Medicine, University of Florida College of Medicine

Joel A Strom, MD, ME is a member of the following medical societies: American Association for the Advancement of Science, American College of Cardiology, American Heart Association, and American Society of Echocardiography

Disclosure: Merck, Inc. Own stock None; Abbott Labs, Inc. own stock None; Medtronic own stock None; General Electric own stock None; Pfizer, Inc. own stock Other

Mingquan Suksanong  Clinical Assistant Professor, Department of Medicine, Division of Infectious Diseases and Tropical Medicine, University of South Florida College of Medicine; Consulting Staff, Department of Medicine, Bayfront Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Craig T Basson, MD, PhD  Gladys and Roland Harriman Professor of Medicine, Director of the Center for Molecular Cardiology, Director of Cardiovascular Research, Division of Cardiology, Department of Medicine, Weill Cornell Medical College; Attending Physician, New York Presbyterian Hospital

Craig T Basson, MD, PhD is a member of the following medical societies: American College of Cardiology and American Heart Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John L Brusch, MD, FACP  Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance

John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

  1. Cossio P, Berconsky I. Abceso parietal del corazon e infarto del myocardio. Seman Med. 1933;2:1691-8.

  2. Gonzalez Vilchez FJ, Martin Duran R, Delgado Ramis C, et al. [Active infective endocarditis complicated by paravalvular abscess. Review of 40 cases]. Rev Esp Cardiol. May 1991;44(5):306-12. [Medline].

  3. Sanson J, Slodki S, Gruhn JG. Myocardial abscesses. Am Heart J. Sep 1963;66:301-8. [Medline].

  4. Castleman B, McNeely BU. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 27-1970. N Engl J Med. Jun 25 1970;282(26):1477-85. [Medline].

  5. Weisz S, Young DG. Myocardial abscess complicating healed myocardial infarction. Can Med Assoc J. May 21 1977;116(10):1156-8. [Medline].

  6. Murdoch DR, Corey GR, Hoen B, Miró JM, Fowler VG Jr, Bayer AS. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. Mar 9 2009;169(5):463-73. [Medline].

  7. van der Meer JT, Thompson J, Valkenburg HA, Michel MF. Epidemiology of bacterial endocarditis in The Netherlands. II. Antecedent procedures and use of prophylaxis. Arch Intern Med. Sep 1992;152(9):1869-73. [Medline].

  8. Hogevik H, Olaison L, Andersson R, et al. Epidemiologic aspects of infective endocarditis in an urban population. A 5-year prospective study. Medicine (Baltimore). Nov 1995;74(6):324-39. [Medline].

  9. Dismukes WE, Karchmer AW, Buckley MJ, et al. Prosthetic valve endocarditis. Analysis of 38 cases. Circulation. Aug 1973;48(2):365-77. [Medline].

  10. Ben Ismail M, Hannachi N, Abid F, et al. Prosthetic valve endocarditis. A survey. Br Heart J. Jul 1987;58(1):72-7. [Medline].

  11. Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation. Jul 1976;54(1):140-5. [Medline].

  12. Ellis SG, Goldstein J, Popp RL. Detection of endocarditis-associated perivalvular abscesses by two- dimensional echocardiography. J Am Coll Cardiol. Mar 1985;5(3):647-53. [Medline].

  13. Walker N, Bhan A, Desai J, Monaghan MJ. Myocardial abscess: a rare complication of valvular endocarditis demonstrated by 3D contrast echocardiography. Eur J Echocardiogr. Dec 2010;11(10):E37. [Medline].

  14. Adachi I, Kobayashi J, Nakajima H. Coronary embolism and subsequent myocardial abscess complicating ventricular aneurysm and tachycardia. Ann Thorac Surg. Dec 2005;80(6):2366-8. [Medline].

  15. Adams BK. Tc-99m leukocyte scintigraphy in infective endocarditis. Clin Nucl Med. May 1995;20(5):395-7. [Medline].

  16. Aguado JM, Gonzalez-Vilchez F, Martin-Duran R, et al. Perivalvular abscesses associated with endocarditis. Clinical features and diagnostic accuracy of two-dimensional echocardiography. Chest. Jul 1993;104(1):88-93. [Medline].

  17. Ait Ben Ali S, Hilmani S, Choukri M, et al. [Multiple cerebral hydatic cysts of cardiac origin. A case report]. Neurochirurgie. Dec 1999;45(5):426-9. [Medline].

  18. Almond DS, Lea BI, Saltissi S, et al. Interventricular septal abscess formation in an HIV-positive man. Int J STD AIDS. Nov 1999;10(11):749-50. [Medline].

  19. Antonov VA. [Electric alternation of the heart in myocardial abscesses]. Kardiologiia. Jul 1991;31(7):49-50. [Medline].

  20. Arruabarrena IM, Von Wichmann MA, Iribarren JA, et al. [Favorable evolution of a myocardial abscess using medical treatment in an HIV-positive patient]. Enferm Infecc Microbiol Clin. Mar 1998;16(3):156. [Medline].

  21. Bajraktari G, Olloni R, Daullxhiu I, Ademaj F, Vela Z, Pajaziti M. MRSA endocarditis of bovine Contegra valved conduit: a case report. Cases J. 2009;2(1):57. [Medline].

  22. Balaguer JM, Soto E, Perry D, Moran JM. Postoperative intramyocardial abscess caused by mucormycosis. Ann Thorac Surg. Dec 1994;58(6):1760-2. [Medline].

  23. Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. Dec 22-29 1998;98(25):2936-48. [Medline]. [Full Text].

  24. Behnam R, Walter S, Hanes V. Myocardial abscess complicating myocardial infarction. J Am Soc Echocardiogr. May-Jun 1995;8(3):334-7. [Medline].

  25. Berman DA, Burgess JB, Steeper TA. Myocardial abscess due to Fusobacterium following acute myocardial infarction. Clin Cardiol. Aug 1988;11(8):575-7. [Medline].

  26. Borowski A, Korb H, Voth E, de Vivie ER. Asymptomatic myocardial abscess. Thorac Cardiovasc Surg. Dec 1988;36(6):338-40. [Medline].

  27. Cerqueira MD, Jacobson AF. Indium-111 leukocyte scintigraphic detection of myocardial abscess formation in patients with endocarditis. J Nucl Med. May 1989;30(5):703-6. [Medline].

  28. Chakrabarti J. Diagnostic evaluation of myocardial abscesses. A new look at an old problem. Int J Cardiol. Dec 1995;52(3):189-96. [Medline].

  29. Chang CH, Huang JY, Lai PC, Yang CW. Posterior mediastinal abscess in a hemodialysis patient - a rare but life-threatening complication of Staphylococcus bacteremia. Clin Nephrol. Jan 2009;71(1):92-5. [Medline].

  30. Chikwe J, Barnard J, Pepper JR. Myocardial abscess. Heart. Jun 2004;90(6):597. [Medline].

  31. Cowan JC, Patrick D, Reid DS. Aortic root abscess complicating bacterial endocarditis. Demonstration by computed tomography. Br Heart J. Nov 1984;52(5):591-3. [Medline].

  32. Dajani AS, Taubert KA, Wilson W. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. Available at http://www.americanheart.org/Scientific/statements/1997/079701.html. JAMA. Jun 11 1997;277(22):1794-801. [Medline].

  33. Daniel WG, Nellessen U, Schroeder E. Trans-esophageal echocardiography as a method of choice for the detection of endocarditis-associated abscess. Circulation. 1986;74(Supl II):55.

  34. Dean JW, Kuo J, Wood AJ. Myocardial infarction due to coronary artery compression by aortic root abscess. Int J Cardiol. Sep 1993;41(2):165-7. [Medline].

  35. Egan TM, Maitland A, Sinave C, et al. Myocardial abscess in a patient with AIDS-related complex: pericardial patch repair. Ann Thorac Surg. Mar 1990;49(3):481-2. [Medline].

  36. Eicher JC, Falcon-Eicher S, Sota FX, et al. Mitral ring abscess caused by bacterial endocarditis on a heavily calcified mitral annulus fibrosus: Diagnosis by multiplane transesophageal echocardiography. Am Heart J. Apr 1996;131(4):818-20. [Medline].

  37. Fan CC, Andersen BR, Sahgal S. Isolated myocardial abscess causing coronary artery rupture and fatal hemopericardium. Arch Pathol Lab Med. Oct 1994;118(10):1023-5. [Medline].

  38. Fredenrich A, Jourdan J, Gibelin P, et al. [Ventricular arrhythmias disclosing myocardial abscess in infectious mitro-aortic endocarditis]. Ann Cardiol Angeiol (Paris). Nov 1990;39(9):531-3. [Medline].

  39. Ghani M, Boughner D. Echocardiographic diagnosis of myocardial abscess complicating myocardial infarction. J Am Soc Echocardiogr. May-Jun 1994;7(3 Pt 1):318-20. [Medline].

  40. Gladden JR. Myocardial abscess with perforation of the heart following Staphylococcal pyemia. Clin Orthop. 1999;362:6-11. [Medline].

  41. Gunther HU, Strupp G, Volmar J, et al. [Coronary stent implantation: infection and abscess with fatal outcome]. Z Kardiol. Aug 1993;82(8):521-5. [Medline].

  42. Harris DG, Rossouw GJ. Myocardial abscess with contained rupture: successful repair. Ann Thorac Surg. 2001;71(4):1360-1. [Medline].

  43. Iqbal J, Ahmed I, Baig W. Metastatic myocardial abscess on the posterior wall of the left ventricle: a case report. J Med Case Reports. 2008;2:258. [Medline].

  44. Katz A. Abscess of the myocardium complicating infarction: report of two cases. Can Med Assoc J. Dec 5 1964;91:1225-7. [Medline].

  45. Khoo DE, Zebro TJ, English TA. Bacterial endocarditis in a transplanted heart. Pathol Res Pract. Oct 1989;185(4):445-7. [Medline].

  46. Kortleve JW, Duren DR, Becker AE. Cardiac aneurysm complicated by Salmonella abscess. A clinicopathologic correlation in two patients. Am J Med. Mar 1980;68(3):395-400. [Medline].

  47. Kurland S, Enghoff E, Landelius J, et al. A 10-year retrospective study of infective endocarditis at a university hospital with special regard to the timing of surgical evaluation in S. viridans endocarditis. Scand J Infect Dis. 1999;31(1):87-91. [Medline].

  48. [Guideline] Little J. The American Heart Association's guidelines for the prevention of bacterial endocarditis: a critical review. Gen Dent. Sep-Oct 1998;46(5):508-15. [Medline].

  49. Lo SS, Ong YE, Sheppard MN, et al. Streptococcal mural endocarditis and myocardial abscess occurring in a left ventricular aneurysm--case report and review. Clin Cardiol. Jun 1998;21(6):435-8. [Medline].

  50. Massachusetts General Hospital. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 46-1989. A 52-year-old diabetic man with myocardial infarction, pericarditis, and persistent fever. N Engl J Med. Nov 16 1989;321(20):1391-402. [Medline].

  51. McIlwaine L, Stott S, Hogg D. Fatal unruptured myocardial abscesses. Available at www.heartjnl.com. Heart. May 2000;83(5):498. [Medline].

  52. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med. Nov 1 2001;345(18):1318-30. [Medline].

  53. Nandish S, Khardori N. Valvular and myocardial abscesses due to Erysipelothrix rhusiopathiae. Clin Infect Dis. 1999;29(5):1351-2. [Medline].

  54. Persaud H, Pande PN, Easley JM Jr, Downing TP. Myocardial abscess complicating acute myocardial infarction. N Y State J Med. Jan 1988;88(1):38-9. [Medline].

  55. Prunier L, Lavergne T, Perier P, et al. [Recurrent myocardial abscess during Streptococcus B endocarditis]. Arch Mal Coeur Vaiss. Jul 1988;81(7):925-8. [Medline].

  56. Recio J, Alegre J, Fernandez de Sevilla T. Myocardial abscess with salmonella infection. Ann Intern Med. Sep 21 1999;131(6):477-8. [Medline].

  57. Roberts JH, Aponte V, Naidich DP, Bhalla M. Myocardial abscess resulting in a pseudoaneurysm: case report. Cardiovasc Intervent Radiol. Sep-Oct 1991;14(5):307-10. [Medline].

  58. Romero-Menor C, Espanol I, Alcaide F, et al. Myocardial abscess at a distant zone from the active valvular infection. J Cardiovasc Surg (Torino). Apr 1998;39(2):227-8. [Medline].

  59. Rosen JM, Murthy S, Hain DR. A comparison of indium-111 leukocyte and gallium-67 scintigraphy in a patient with a myocardial abscess. Clin Nucl Med. Nov 1993;18(11):997-8. [Medline].

  60. Ryon DS, Pastor BH, Myerson RM. Abscess of the myocardium. Am J Med Sci. Jun 1966;251(6):698-705. [Medline].

  61. Sheppard RC, Chandrasekaran K, Ross J, Mintz GS. An acquired interatrial fistula secondary to para-aortic abscess documented by transesophageal echocardiography. J Am Soc Echocardiogr. May-Jun 1991;4(3):271-6. [Medline].

  62. Smith RE, Martin JE, Mills PG. Myocardial abscess and sternal osteomyelitis following myocardial infarction and resuscitation. Postgrad Med J. Aug 1989;65(766):589-90. [Medline].

  63. Sproule MW, Briggs MJ. Salmonellosis complicated by myocardial abscess and cerebral mycotic aneurysms. Br J Clin Pract. Sep-Oct 1995;49(5):273-4. [Medline].

  64. Tedeschi CG, Stevenson TD Jr, Levenson HM. Abscess formation in myocardial infarction. N Engl J Med. Dec 28 1950;243(26):1024-7. [Medline].

  65. Tennant R, Parks HW. Myocardial abscesses. A study of pathogenesis with report of a case. Arch Pathol. Oct 1959;68:456-60. [Medline].

  66. Terry SM, Ryan PE Jr. Penetrating mitral valve annular abscess. J Heart Valve Dis. Nov 1997;6(6):621-4. [Medline].

  67. Thomas D, Choussat R, Isnard R, et al. [Cardiac abscess in infectious endocarditis. A multicenter study apropos of 233 cases. The Working Group on Valvulopathy of the French Society of Cardiology]. Arch Mal Coeur Vaiss. Jun 1998;91(6):745-52. [Medline].

  68. Thomas D, Desruennes M, Jault F, et al. [Cardiac and extracardiac abscesses in bacterial endocarditis]. Arch Mal Coeur Vaiss. Dec 1993;86(12 Suppl):1825-35. [Medline].

  69. Timsit JF, Wolff MA, Bedos JP, et al. Cardiac abscess following percutaneous transluminal coronary angioplasty. Chest. Feb 1993;103(2):639-41. [Medline].

  70. Valencia ME, Guinea J, Moreno V, González Lahoz JM. [Myocardial abscess without concomitant valve lesion and parenteral drug addiction]. Rev Clin Esp. Oct 1992;191(5):289. [Medline].

  71. Vinereanu D, Musumeci F, Fraser AG. Diagnosis of Myocardial Abscess After Acute Myocardial Infarction by Transesophageal Echocardiography: Case Report and Short Review of Published Data. Echocardiography. Aug 1999;16(6):581-584. [Medline].

  72. Völker U, Kraft P. [An unusual cause of myocardial infarct. Bacterial mitral valve endocarditis, valve ring and myocardial abscess with direct coronary lesion]. Z Kardiol. May 1993;82(5):287-92. [Medline].

  73. Weernink EE, de Boer MJ, Brutel de la Rivière A. Myocardial abscess after silent myocardial infarction. Thorac Cardiovasc Surg. Apr 1989;37(2):103-4. [Medline].

  74. Weinstein LW, Brusch JL. Infective Endocarditis. New York, NY: Oxford University Press; 1996:175-7.

  75. Wickline CL, Goli VD, Buell JC. Coronary artery narrowing due to extrinsic compression by myocardial abscess. Cathet Cardiovasc Diagn. Jun 1991;23(2):121-3. [Medline].

  76. Wilson WR, Karchmer AW, Dajani AS. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. Available at http://www.americanheart.org/Scientific/statements/1995/129501.html. JAMA. Dec 6 1995;274(21):1706-13. [Medline].

  77. Winek RR, Schwenk NM, Edwards WD. Fatal hemopericardium due to ruptured solitary myocardial abscess unassociated with infective endocarditis. Am J Cardiovasc Pathol. 1988;2(3):255-7. [Medline].

  78. Witham M, Dittmer I, Williams A, et al. Myocardial abscess: an unusual complication of long-term hemodialysis line presence. Clin Nephrol. Mar 1999;51(3):193-4. [Medline].

  79. Zeineddin M, Stewart JA. Echocardiographic detection of non-valve-ring myocardial abscess complicating aortic valve endocarditis. Am J Med. Jul 1988;85(1):97-9. [Medline].

 
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Myocardial abscess. Transesophageal echocardiogram exhibiting aortic valvular endocarditis and aortic root abscess.
Myocardial abscess. Complete heart block seen on a 12-lead electrocardiogram in a patient with myocardial abscess involving the prosthetic aortic valve ring.
Myocardial abscess. Color Doppler imaging showing flow into the aortic root abscess.
Myocardial abscess. Aortic valvular ring abscess seen by transesophageal echocardiography.
Myocardial abscess (gross).
Myocardial abscess (opened).
 
 
 
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