Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1990 Feb;63(2):109–113. doi: 10.1136/hrt.63.2.109

Enhanced morphological diagnosis in infective endocarditis by transoesophageal echocardiography.

M A Taams 1, E J Gussenhoven 1, E Bos 1, P de Jaegere 1, J R Roelandt 1, G R Sutherland 1, N Bom 1
PMCID: PMC1024336  PMID: 2317403

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.

Full text

PDF
109

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson D. J., Bulkley B. H., Hutchins G. M. A clinicopathologic study of prosthetic valve endocarditis in 22 patients: morphologic basis for diagnosis and therapy. Am Heart J. 1977 Sep;94(3):325–332. doi: 10.1016/s0002-8703(77)80475-4. [DOI] [PubMed] [Google Scholar]
  2. Arnett E. N., Roberts W. C. Prosthetic valve endocarditis: clinicopathologic analysis of 22 necropsy patients with comparison observations in 74 necropsy patients with active infective endocarditis involving natural left-sided cardiac valves. Am J Cardiol. 1976 Sep;38(3):281–292. doi: 10.1016/0002-9149(76)90169-7. [DOI] [PubMed] [Google Scholar]
  3. Arnett E. N., Roberts W. C. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to clinical diagnosis from the study of 95 necropsy patients. Circulation. 1976 Jul;54(1):140–145. doi: 10.1161/01.cir.54.1.140. [DOI] [PubMed] [Google Scholar]
  4. Becher H., Hanrath P., Bleifeld W., Bleese N. Correlation of echocardiographic and surgical findings in acute bacterial endocarditis. Eur Heart J. 1984 Oct;5 (Suppl 100):67–70. doi: 10.1093/eurheartj/5.suppl_c.67. [DOI] [PubMed] [Google Scholar]
  5. Brandenburg R. O., Giuliani E. R., Wilson W. R., Geraci J. E. Infective endocarditis--a 25 year overview of diagnosis and therapy. J Am Coll Cardiol. 1983 Jan;1(1):280–291. doi: 10.1016/s0735-1097(83)80029-1. [DOI] [PubMed] [Google Scholar]
  6. Cowgill L. D., Addonizio V. P., Hopeman A. R., Harken A. H. A practical approach to prosthetic valve endocarditis. Ann Thorac Surg. 1987 Apr;43(4):450–457. doi: 10.1016/s0003-4975(10)62835-4. [DOI] [PubMed] [Google Scholar]
  7. Croft C. H., Woodward W., Elliott A., Commerford P. J., Barnard C. N., Beck W. Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis. Am J Cardiol. 1983 Jun;51(10):1650–1655. doi: 10.1016/0002-9149(83)90203-5. [DOI] [PubMed] [Google Scholar]
  8. Donaldson R. M., Westgate C., Bennett J. G., Rickards A. F. The role of echocardiography in suspected bacterial endocarditis. Eur Heart J. 1984 Oct;5 (Suppl 100):53–57. doi: 10.1093/eurheartj/5.suppl_c.53. [DOI] [PubMed] [Google Scholar]
  9. Ellis S. G., Goldstein J., Popp R. L. Detection of endocarditis-associated perivalvular abscesses by two-dimensional echocardiography. J Am Coll Cardiol. 1985 Mar;5(3):647–653. doi: 10.1016/s0735-1097(85)80390-9. [DOI] [PubMed] [Google Scholar]
  10. Gussenhoven E. J., Taams M. A., Roelandt J. R., Ligtvoet K. M., McGhie J., van Herwerden L. A., Cahalan M. K. Transesophageal two-dimensional echocardiography: its role in solving clinical problems. J Am Coll Cardiol. 1986 Oct;8(4):975–979. doi: 10.1016/s0735-1097(86)80444-2. [DOI] [PubMed] [Google Scholar]
  11. Gussenhoven E. J., Taams M. A., Roelandt J., Bom K., Honkoop J., de Jong N., Ligtvoet K. M. Oesophageal echocardiography. Int J Card Imaging. 1987;2(4):231–239. doi: 10.1007/BF01784779. [DOI] [PubMed] [Google Scholar]
  12. Gussenhoven E. J., van Herwerden L. A., Roelandt J., Bos E., de Jong N. Detailed analysis of aortic valve endocarditis: comparison of precordial, esophageal and epicardial two-dimensional echocardiography with surgical findings. J Clin Ultrasound. 1986 Mar-Apr;14(3):209–211. doi: 10.1002/jcu.1870140311. [DOI] [PubMed] [Google Scholar]
  13. Melvin E. T., Berger M., Lutzker L. G., Goldberg E., Mildvan D. Noninvasive methods for detection of valve vegetations in infective endocarditis. Am J Cardiol. 1981 Feb;47(2):271–278. doi: 10.1016/0002-9149(81)90397-0. [DOI] [PubMed] [Google Scholar]
  14. Mintz G. S., Kotler M. N. Clinical value and limitations of echocardiography. Its use in the study of patients with infectious endocarditis. Arch Intern Med. 1980 Aug;140(8):1022–1027. [PubMed] [Google Scholar]
  15. Neimann J. L., Danchin N., Godenier J. P., Villemot J. P., Faivre G. Two-dimensional echocardiographic recognition of aortic valve ring abscess. Eur Heart J. 1984 Oct;5 (Suppl 100):59–65. doi: 10.1093/eurheartj/5.suppl_c.59. [DOI] [PubMed] [Google Scholar]
  16. O'Brien J. T., Geiser E. A. Infective endocarditis and echocardiography. Am Heart J. 1984 Aug;108(2):386–394. doi: 10.1016/0002-8703(84)90630-6. [DOI] [PubMed] [Google Scholar]
  17. Polak P. E., Gussenhoven W. J., Roelandt J. R. Transoesophageal cross-sectional echocardiographic recognition of an aortic valve ring abscess and a subannular mycotic aneurysm. Eur Heart J. 1987 Jun;8(6):664–666. doi: 10.1093/oxfordjournals.eurheartj.a062340. [DOI] [PubMed] [Google Scholar]
  18. Pollak S. J., Felner J. M. Echocardiographic identification of an aortic valve ring abscess. J Am Coll Cardiol. 1986 May;7(5):1167–1173. doi: 10.1016/s0735-1097(86)80240-6. [DOI] [PubMed] [Google Scholar]
  19. Sareli P., Klein H. O., Schamroth C. L., Goldman A. P., Antunes M. J., Pocock W. A., Barlow J. B. Contribution of echocardiography and immediate surgery to the management of severe aortic regurgitation from active infective endocarditis. Am J Cardiol. 1986 Feb 15;57(6):413–418. doi: 10.1016/0002-9149(86)90763-0. [DOI] [PubMed] [Google Scholar]
  20. Scanlan J. G., Seward J. B., Tajik A. J. Valve ring abscess in infective endocarditis: visualization with wide angle two dimensional echocardiography. Am J Cardiol. 1982 May;49(7):1794–1800. doi: 10.1016/0002-9149(82)90261-2. [DOI] [PubMed] [Google Scholar]
  21. Stewart J. A., Silimperi D., Harris P., Wise N. K., Fraker T. D., Jr, Kisslo J. A. Echocardiographic documentation of vegetative lesions in infective endocarditis: clinical implications. Circulation. 1980 Feb;61(2):374–380. doi: 10.1161/01.cir.61.2.374. [DOI] [PubMed] [Google Scholar]
  22. Taams M. A., Gussenhoven E. J., Cornel J. H., The S. H., Roelandt J. R., Lancée C. T., vd Brand M. Detection of left coronary artery stenosis by transoesophageal echocardiography. Eur Heart J. 1988 Nov;9(11):1162–1166. doi: 10.1093/oxfordjournals.eurheartj.a062424. [DOI] [PubMed] [Google Scholar]
  23. Taams M. A., Gussenhoven W. J., Schippers L. A., Roelandt J., van Herwerden L. A., Bos E., de Jong N., Bom N. The value of transoesophageal echocardiography for diagnosis of thoracic aorta pathology. Eur Heart J. 1988 Dec;9(12):1308–1316. doi: 10.1093/oxfordjournals.eurheartj.a062448. [DOI] [PubMed] [Google Scholar]
  24. Westaby S., Oakley C., Sapsford R. N., Bentall H. H. Surgical treatment of infective endocarditis with special reference to prosthetic valve endocarditis. Br Med J (Clin Res Ed) 1983 Jul 30;287(6388):320–323. doi: 10.1136/bmj.287.6388.320. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. van Herwerden L. A., Gussenhoven E. J., Roelandt J. R., Haalebos M. M., Mochtar B., Ligtvoet K. M., Bos E. Intraoperative two-dimensional echocardiography in complicated infective endocarditis of the aortic valve. J Thorac Cardiovasc Surg. 1987 Apr;93(4):587–591. [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES