Improvement in the Diagnosis of Abscesses Associated with Endocarditis by Transesophageal Echocardiography

Daniel, Werner G.; Mügge, Andreas; Martin, Randolph P.; Lindert, Oliver; Hausmann, Dirk; Nonnast-Daniel, B.; Laas, J.; Lichtlen, Paul R.

doi:10.1056/nejm199103213241203

Cited by 646 publications

(251 citation statements)

References 32 publications

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“…TEE, for example, is known to have higher sensitivity for detection of paravalvular abscess formation and prosthetic valve endocarditis [31,32]. The modality used in a given patient represented the optimal choice for decision making in the specific situation.…”

Section: Limitationsmentioning

confidence: 99%

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

2013

Cardiovasc Med

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SummaryBackground: The optimal timing of the initial echocardiographic assessment and the influence of microorganisms on echocardiographic findings in patients with infective endocarditis (IE) are not well studied.Methods: In 274 patients with IE, we studied the impact of antibiotic treatment duration of ≤2 days (early, 119 patients) or >2 days (late, 144 patients) prior to diagnostic echocardiography on IE specific findings and on clinical outcomes. Results were stratified for patients with Staphylococcus aureus (SA patients, n = 84) and those with other causative organisms (non-SA patients, n = 190).Results: There were no differences on specific echocardiographic findings between patients with early versus late echocardiography: Presence of vegetations: 91% vs 86%, p = 0.25; size of vegetations: 1.5 ± 0.7 cm vs 1.5 ± 0.8 cm, p = 0.83; paravalvular abscess: 24% vs 24%, p = 0.88, or valve destruction: 44% vs 35%, p = 0.17. There were also no differences in terms of clinical outcomes between the two groups: Heart surgery for IE in 61% vs 53%, p = 0.21, and in-hospital death in 8% vs 11%, p = 0.46. The presence of SA was not associated with specific findings on echocardiography or worse clinical outcomes compared to non-SA patients.Conclusions: In patients with infective endocarditis, the findings of early vs late initial echocardiographic a ssessment did not differ, and echocardiographic findings did not allow inference on the causing organism. Neither the timing of the initial echocardiographic study nor any organism involved was associated with clinical outcome.

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Section: Limitationsmentioning

confidence: 99%

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

2013

Cardiovasc Med

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“…The incremental benefit of TEE over transthoracic imaging in the detection of small mitral vegetations and mitral annular abscess has been well described (5). An earlier TEE in the present case would likely have hastened diagnosis and might have avoided the rapid enlargement of the abscess past the point of hemodynamic tolerance.…”

Section: Discussionmentioning

confidence: 59%

Mitral stenosis and cardiogenic shock from an obstructive abscess of the mitral annulus

Kobulnik¹,

Hutchison²

2008

Canadian Journal of Cardiology

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E ndocarditis may be responsible for heart failure and some cases of cardiogenic shock, usually by causing valvular insufficiency. Deep tissue invasion by endocarditis may result in abscesses, which may degenerate into fistulas and dehiscence. We report a case of cardiogenic shock due to an obstructive annular abscess from mitral endocarditis. CASE PRESENTATIONA 48-year-old female hemodialysis patient presented after three weeks of worsening intermittent chest pain and hypotension during dialysis. She also complained of 24 h of fever and chills. Her history included a failed renal transplant 12 years earlier and an inferior myocardial infarction one year previously.For three weeks, the patient had been experiencing episodic retrosternal chest discomfort while undergoing dialysis. These episodes were associated with transient decreases in blood pressure. On the day before admission, the patient experienced further retrosternal chest pain. She was found to be febrile (39°C), and an electrocardiogram demonstrated new T wave inversion in leads V4 through V6. Troponin I was marginally elevated (0.13 μg/L). The patient discharged herself against medical advice, but returned to hospital the following day, when she was informed that her blood cultures were growing Gram-positive cocci.On admission, her temperature was 40.3°C and her blood pressure was 85/50 mmHg. There was a mid-systolic ejection murmur and a holosystolic murmur radiating to the apex. Her white blood cell count was elevated (14×10 9 /L) with neutrophilia. Her troponin I level had become significantly elevated (2.29 μg/L).During the first seven days of admission, the patient experienced intermittent chest pain. Her blood pressure remained stable, but the mild fever persisted. The initial echocardiogram revealed nonspecific, small mitral echo-densities and increased mitral annular lucency, but no obvious vegetations. There was prominent submitral calcification ( Figure 1). No probable evidence of infection was present on vascular ultrasound examination of the right arm fistula. Transesophageal echocardiography (TEE) and other tests were refused by the patient. Cephalosporin-sensitive Staphylococcus aureus was speciated from the blood cultures, and antibiotic therapy was changed from empirical vancomycin to cefazolin.On the eighth day of hospitalization, the patient's condition abruptly deteriorated, with the development of severe hypotension and the onset of pulmonary edema. The hypotension was notably worsened by aggressive ultrafiltration. A repeat transthoracic echocardiogram revealed a large and complex mass involving the mitral annulus and valve from the posterior aspect. The submitral calcification had displaced anteriorly into the left heart and rocked posteriorly with the ventricular systole, akin to dehiscence of a mitral prosthesis. The mitral annulus contained a large, thin-walled lucent cavity consistent A 48-year-old female hemodialysis patient with Gram-positive mitral endocarditis developed progressive hemodynamic collapse. Echocardiography ...

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“…Transesophageal echo is also superior to TTE for diagnosing complications of IE. In a study comparing the two modalities for the diagnosis of abscess confirmed during surgery or at autopsy in 118 patients, the sensitivity of TTE was only 28.3% compared to 87% with TEE [15].…”

Section: Role Of Echocardiography In Diagnosismentioning

confidence: 99%

Infective Endocarditis: Diagnosis and Management, up-to-date

Martin

2005

J Echocardiogr

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Improvement in the Diagnosis of Abscesses Associated with Endocarditis by Transesophageal Echocardiography

Cited by 646 publications

References 32 publications

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

Early versus late initial echocardiographic assessment in infective endocarditis: similar findings and no difference in clinical outcome

Mitral stenosis and cardiogenic shock from an obstructive abscess of the mitral annulus

Infective Endocarditis: Diagnosis and Management, up-to-date

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