Enhanced morphological diagnosis in infective endocarditis by transoesophageal echocardiography.

Abstract

Thirty three consecutive patients with clinically suspected endocarditis were studied by both precordial cross sectional echocardiography and transoesophageal echocardiography. The diagnostic value of both techniques was assessed. The data were compared with findings at operation in 25 patients. In 21 patients with native valve endocarditis precordial echocardiography showed evidence of vegetations in six patients and suggested their presence in nine. Transoesophageal echocardiography identified vegetations in 18 patients. Complications were seen in four patients at precordial echocardiography and in nine patients at transoesophageal echocardiography. Precordial echocardiography did not show vegetations in any of the 12 patients with prosthetic valve endocarditis whereas transoesophageal echocardiography showed vegetations in four. Complications were seen in four patients at precordial echocardiography and in 10 at transoesophageal echocardiography. Echocardiographic findings were confirmed at operation in all 25 operated patients. In two patients both echocardiographic techniques had missed the perforation of the cusps of the aortic valve that was seen at operation, but this had no effect on patient management. Transoesophageal echocardiography is the best diagnostic approach when infective endocarditis is suspected in patients with either native or prosthetic valves.

Characteristics of infective endocarditis in a developing country-clinical profile and outcome in 192 Indian patients, 1992–2001

“…It was especially important because of low culture positivity (only 67.7%) in our series. Vegetation were detected in 89.9% episodes in our study, which is comparable to Taams et al [30] (86.0%), but higher than most others [3][4][5][8][9][10][11]. Use of TEE in patients with clinically suspected IE but nondiagnostic TEE probably explains the higher incidence of vegetations in our study and that by Taams et al Our study reinforces the recently suggested value of echocardiography in diagnosing IE [31].…”

Proposed Modifications to the Duke Criteria for the Diagnosis of Infective Endocarditis

“…The original Duke criteria relied heavily on the results of TTE; the impact of the results from TEE had not been systemically evaluated. The superior sensitivity of TEE for detecting vegetations has now been well established [27][28][29][30], particularly in patients with prosthetic valves [18]. Lindner et al have evaluated the diagnostic value of TEE in suspected IE on the basis of the pretest probability of disease by using clinical criteria that were not Duke criteria [20].…”

The value of transthoracic and transesophageal echocardiography for the diagnosis of the native aortic infective endocarditis valve complications: a case report and literature review.

“…As perivalvular IE is usually associated with a higher incidence of serious complications, a more complicated surgical procedure, or death, early diagnosis is essential [11]. Useful information concerning the diagnosis and the severity of IE, as well as the short-and long-term prognosis are given by TEE [12].…”