Skip to main content
NCBI home page
The Texas Heart Institute Journal logoLink to The Texas Heart Institute Journal
. 1996;23(2):98–107.

Utility of transesophageal echocardiography in infective endocarditis. A review.

C Jessurun 1, A Mesa 1, S Wilansky 1
PMCID: PMC325322  PMID: 8792540

Abstract

Despite recent diagnostic and therapeutic advances, infective endocarditis continues to be a very serious illness, with high patient morbidity and mortality rates. The diagnosis of infective endocarditis has been based primarily on clinical signs and positive blood cultures. Echocardiography is currently recognized as the technique of choice for the detection of valvular vegetations, which are the hallmark of endocarditis. We briefly review the use of echocardiography in the diagnosis of suspected infective endocarditis, with emphasis on transesophageal echocardiography. High-resolution imaging of the cardiac valves with transesophageal echocardiography has proved to be invaluable in the management of infective endocarditis.

Full text

PDF
98

Images in this article

102Image
on p.102
102Image
on p.102
103Image
on p.103

Selected References

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

  1. Alam M., Serwin J. B., Rosman H. S., Sheth M., Sun I., Silverman N. A., Goldstein S. Transesophageal color flow Doppler and echocardiographic features of normal and regurgitant St. Jude Medical prostheses in the aortic valve position. Am J Cardiol. 1990 Oct 1;66(10):873–875. doi: 10.1016/0002-9149(90)90373-9. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. 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]
  4. Boucher C. A., Fallon J. T., Myers G. S., Hutter A. M., Jr, Buckley M. J. The value and limitations of echocardiography in recording mitral valve vegetations. Am Heart J. 1977 Jul;94(1):37–43. doi: 10.1016/s0002-8703(77)80341-4. [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. Buchbinder N. A., Roberts W. C. Left-sided valvular active infective endocarditis. A study of forty-five necropsy patients. Am J Med. 1972 Jul;53(1):20–35. doi: 10.1016/0002-9343(72)90112-x. [DOI] [PubMed] [Google Scholar]
  7. Buda A. J., Zotz R. J., LeMire M. S., Bach D. S. Prognostic significance of vegetations detected by two-dimensional echocardiography in infective endocarditis. Am Heart J. 1986 Dec;112(6):1291–1296. doi: 10.1016/0002-8703(86)90362-5. [DOI] [PubMed] [Google Scholar]
  8. Byrd B. F., 3rd, Shelton M. E., Wilson B. H., 3rd, Schillig S. Infective perivalvular abscess of the aortic ring: echocardiographic features and clinical course. Am J Cardiol. 1990 Jul 1;66(1):102–105. doi: 10.1016/0002-9149(90)90745-m. [DOI] [PubMed] [Google Scholar]
  9. Come P. C., Isaacs R. E., Riley M. F. Diagnostic accuracy of M-mode echocardiography in active infective endocarditis and prognostic implications of ultrasound-detectable vegetations. Am Heart J. 1982 May;103(5):839–847. doi: 10.1016/0002-8703(82)90397-0. [DOI] [PubMed] [Google Scholar]
  10. 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]
  11. Daniel W. G., Mügge A., Grote J., Hausmann D., Nikutta P., Laas J., Lichtlen P. R., Martin R. P. Comparison of transthoracic and transesophageal echocardiography for detection of abnormalities of prosthetic and bioprosthetic valves in the mitral and aortic positions. Am J Cardiol. 1993 Jan 15;71(2):210–215. doi: 10.1016/0002-9149(93)90740-4. [DOI] [PubMed] [Google Scholar]
  12. Daniel W. G., Mügge A., Martin R. P., Lindert O., Hausmann D., Nonnast-Daniel B., Laas J., Lichtlen P. R. Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography. N Engl J Med. 1991 Mar 21;324(12):795–800. doi: 10.1056/NEJM199103213241203. [DOI] [PubMed] [Google Scholar]
  13. Daniel W. G., Mügge A. Transesophageal echocardiography. N Engl J Med. 1995 May 11;332(19):1268–1279. doi: 10.1056/NEJM199505113321906. [DOI] [PubMed] [Google Scholar]
  14. Daniel W. G., Pearlman A. S., Hausmann D., Bargheer K., Mügge A., Nonnast-Daniel B., Lichtlen P. R. Initial experience and potential applications of multiplane transesophageal echocardiography. Am J Cardiol. 1993 Feb 1;71(4):358–361. doi: 10.1016/0002-9149(93)90811-p. [DOI] [PubMed] [Google Scholar]
  15. Davis R. S., Strom J. A., Frishman W., Becker R., Matsumoto M., LeJemtel T. H., Sonnenblick E. H., Frater R. W. The demonstration of vegetations by echocardiography in bacterial endocarditis. An indication for early surgical intervention. Am J Med. 1980 Jul;69(1):57–63. doi: 10.1016/0002-9343(80)90500-8. [DOI] [PubMed] [Google Scholar]
  16. Dillon J. C., Feigenbaum H., Konecke L. L., Davis R. H., Chang S. Echocardiographic manifestations of valvular vegetations. Am Heart J. 1973 Nov;86(5):698–704. doi: 10.1016/0002-8703(73)90350-5. [DOI] [PubMed] [Google Scholar]
  17. Durack D. T., Lukes A. S., Bright D. K. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994 Mar;96(3):200–209. doi: 10.1016/0002-9343(94)90143-0. [DOI] [PubMed] [Google Scholar]
  18. Effron M. K., Popp R. L. Two-dimensional echocardiographic assessment of bioprosthetic valve dysfunction and infective endocarditis. J Am Coll Cardiol. 1983 Oct;2(4):597–606. doi: 10.1016/s0735-1097(83)80298-8. [DOI] [PubMed] [Google Scholar]
  19. Erbel R., Rohmann S., Drexler M., Mohr-Kahaly S., Gerharz C. D., Iversen S., Oelert H., Meyer J. Improved diagnostic value of echocardiography in patients with infective endocarditis by transoesophageal approach. A prospective study. Eur Heart J. 1988 Jan;9(1):43–53. [PubMed] [Google Scholar]
  20. Flachskampf F. A., Hoffmann R., Verlande M., Schneider W., Ameling W., Hanrath P. Initial experience with a multiplane transoesophageal echo-transducer: assessment of diagnostic potential. Eur Heart J. 1992 Sep;13(9):1201–1206. doi: 10.1093/oxfordjournals.eurheartj.a060338. [DOI] [PubMed] [Google Scholar]
  21. Frazin L., Talano J. V., Stephanides L., Loeb H. S., Kopel L., Gunnar R. M. Esophageal echocardiography. Circulation. 1976 Jul;54(1):102–108. doi: 10.1161/01.cir.54.1.102. [DOI] [PubMed] [Google Scholar]
  22. Gilbert B. W., Haney R. S., Crawford F., McClellan J., Gallis H. A., Johnson M. L., Kisslo J. A. Two-dimensional echocardiographic assessment of vegetative endocarditis. Circulation. 1977 Feb;55(2):346–353. doi: 10.1161/01.cir.55.2.346. [DOI] [PubMed] [Google Scholar]
  23. Ginzton L. E., Siegel R. J., Criley J. M. Natural history of tricuspid valve endocarditis: a two dimensional echocardiographic study. Am J Cardiol. 1982 Jun;49(8):1853–1859. doi: 10.1016/0002-9149(82)90202-8. [DOI] [PubMed] [Google Scholar]
  24. Hanrath P., Schlüter M., Langenstein B. A., Polster J., Engel S., Kremer P., Krebber H. J. Detection of ostium secundum atrial septal defects by transoesophageal cross-sectional echocardiography. Br Heart J. 1983 Apr;49(4):350–358. doi: 10.1136/hrt.49.4.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Herrera C. J., Mehlman D. J., Hartz R. S., Talano J. V., McPherson D. D. Comparison of transesophageal and transthoracic echocardiography for diagnosis of right-sided cardiac lesions. Am J Cardiol. 1992 Oct 1;70(9):964–966. doi: 10.1016/0002-9149(92)90751-j. [DOI] [PubMed] [Google Scholar]
  26. Hickey A. J., Wolfers J., Wilcken D. E. Reliability and clinical relevance of detection of vegetations by echocardiography in bacterial endocarditis. Br Heart J. 1981 Dec;46(6):624–628. doi: 10.1136/hrt.46.6.624. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Jaffe W. M., Morgan D. E., Pearlman A. S., Otto C. M. Infective endocarditis, 1983-1988: echocardiographic findings and factors influencing morbidity and mortality. J Am Coll Cardiol. 1990 May;15(6):1227–1233. doi: 10.1016/s0735-1097(10)80005-1. [DOI] [PubMed] [Google Scholar]
  28. Job F. P., Franke S., Lethen H., Flachskampf F. A., Hanrath P. Incremental value of biplane and multiplane transesophageal echocardiography for the assessment of active infective endocarditis. Am J Cardiol. 1995 May 15;75(15):1033–1037. doi: 10.1016/s0002-9149(99)80719-x. [DOI] [PubMed] [Google Scholar]
  29. Karalis D. G., Bansal R. C., Hauck A. J., Ross J. J., Jr, Applegate P. M., Jutzy K. R., Mintz G. S., Chandrasekaran K. Transesophageal echocardiographic recognition of subaortic complications in aortic valve endocarditis. Clinical and surgical implications. Circulation. 1992 Aug;86(2):353–362. doi: 10.1161/01.cir.86.2.353. [DOI] [PubMed] [Google Scholar]
  30. Karalis D. G., Chandrasekaran K., Ross J. J., Jr, Micklin A., Brown B. M., Ren J. F., Mintz G. S. Single-plane transesophageal echocardiography for assessing function of mechanical or bioprosthetic valves in the aortic valve position. Am J Cardiol. 1992 May 15;69(16):1310–1315. doi: 10.1016/0002-9149(92)91227-u. [DOI] [PubMed] [Google Scholar]
  31. Klodas E., Edwards W. D., Khandheria B. K. Use of transesophageal echocardiography for improving detection of valvular vegetations in subacute bacterial endocarditis. J Am Soc Echocardiogr. 1989 Nov-Dec;2(6):386–389. doi: 10.1016/s0894-7317(89)80039-2. [DOI] [PubMed] [Google Scholar]
  32. Lowry R. W., Zoghbi W. A., Baker W. B., Wray R. A., Quiñones M. A. Clinical impact of transesophageal echocardiography in the diagnosis and management of infective endocarditis. Am J Cardiol. 1994 Jun 1;73(15):1089–1091. doi: 10.1016/0002-9149(94)90288-7. [DOI] [PubMed] [Google Scholar]
  33. Lukes A. S., Bright D. K., Durack D. T. Diagnosis of infective endocarditis. Infect Dis Clin North Am. 1993 Mar;7(1):1–8. [PubMed] [Google Scholar]
  34. Lutas E. M., Roberts R. B., Devereux R. B., Prieto L. M. Relation between the presence of echocardiographic vegetations and the complication rate in infective endocarditis. Am Heart J. 1986 Jul;112(1):107–113. doi: 10.1016/0002-8703(86)90687-3. [DOI] [PubMed] [Google Scholar]
  35. Martin R. P., Meltzer R. S., Chia B. L., Stinson E. B., Rakowski H., Popp R. L. Clinical utility of two dimensional echocardiography in infective endocarditis. Am J Cardiol. 1980 Sep;46(3):379–385. doi: 10.1016/0002-9149(80)90004-1. [DOI] [PubMed] [Google Scholar]
  36. Melendez L. J., Chan K. L., Cheung P. K., Sochowski R. A., Wong S., Austin T. W. Incidence of bacteremia in transesophageal echocardiography: a prospective study of 140 consecutive patients. J Am Coll Cardiol. 1991 Dec;18(7):1650–1654. doi: 10.1016/0735-1097(91)90498-x. [DOI] [PubMed] [Google Scholar]
  37. Mintz G. S., Kotler M. N., Segal B. L., Parry W. R. Comparison of two-dimensional and M-mode echocardiography in the evaluation of patients with infective endocarditis. Am J Cardiol. 1979 Apr;43(4):738–744. doi: 10.1016/0002-9149(79)90072-9. [DOI] [PubMed] [Google Scholar]
  38. Mintz G. S., Kotler M. N., Segal B. L., Parry W. R. Survival of patients with aortic valve endocarditis. The prognostic implications of the echocardiogram. Arch Intern Med. 1979 Aug;139(8):862–866. [PubMed] [Google Scholar]
  39. Mügge A., Daniel W. G., Frank G., Lichtlen P. R. Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach. J Am Coll Cardiol. 1989 Sep;14(3):631–638. doi: 10.1016/0735-1097(89)90104-6. [DOI] [PubMed] [Google Scholar]
  40. Mügge A. Echocardiographic detection of cardiac valve vegetations and prognostic implications. Infect Dis Clin North Am. 1993 Dec;7(4):877–898. [PubMed] [Google Scholar]
  41. Nikutta P., Mantey-Stiers F., Becht I., Hausmann D., Mügge A., Böhm T., Pletschette M., Daniel W. G. Risk of bacteremia induced by transesophageal echocardiography: analysis of 100 consecutive procedures. J Am Soc Echocardiogr. 1992 Mar-Apr;5(2):168–172. doi: 10.1016/s0894-7317(14)80548-8. [DOI] [PubMed] [Google Scholar]
  42. 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]
  43. Omoto R., Kyo S., Matsumura M., Yamada E., Matsunaka T. Variomatrix--a newly developed transesophageal echocardiography probe with a rotating matrix biplane transducer. Technological aspects and initial clinical experience. Echocardiography. 1993 Jan;10(1):79–84. doi: 10.1111/j.1540-8175.1993.tb00014.x. [DOI] [PubMed] [Google Scholar]
  44. Pandian N. G., Hsu T. L., Schwartz S. L., Weintraub A., Cao Q. L., Schneider A. T., Gordon G., England M., Simonetti J. Multiplane transesophageal echocardiography. Imaging planes, echocardiographic anatomy, and clinical experience with a prototype phased array OmniPlane probe. Echocardiography. 1992 Nov;9(6):649–666. doi: 10.1111/j.1540-8175.1992.tb00511.x. [DOI] [PubMed] [Google Scholar]
  45. Panidis I. P., Kotler M. N., Mintz G. S., Segal B. L., Ross J. J. Right heart endocarditis: clinical and echocardiographic features. Am Heart J. 1984 Apr;107(4):759–764. doi: 10.1016/0002-8703(84)90325-9. [DOI] [PubMed] [Google Scholar]
  46. Pedersen W. R., Walker M., Olson J. D., Gobel F., Lange H. W., Daniel J. A., Rogers J., Longe T., Kane M., Mooney M. R. Value of transesophageal echocardiography as an adjunct to transthoracic echocardiography in evaluation of native and prosthetic valve endocarditis. Chest. 1991 Aug;100(2):351–356. doi: 10.1378/chest.100.2.351. [DOI] [PubMed] [Google Scholar]
  47. RODBARD S. Blood velocity and endocarditis. Circulation. 1963 Jan;27:18–28. doi: 10.1161/01.cir.27.1.18. [DOI] [PubMed] [Google Scholar]
  48. Robbins M. J., Frater R. W., Soeiro R., Frishman W. H., Strom J. A. Influence of vegetation size on clinical outcome of right-sided infective endocarditis. Am J Med. 1986 Feb;80(2):165–171. doi: 10.1016/0002-9343(86)90004-5. [DOI] [PubMed] [Google Scholar]
  49. Roelandt J. R., Thomson I. R., Vletter W. B., Brommersma P., Bom N., Linker D. T. Multiplane transesophageal echocardiography: latest evolution in an imaging revolution. J Am Soc Echocardiogr. 1992 Jul-Aug;5(4):361–367. doi: 10.1016/s0894-7317(14)80268-x. [DOI] [PubMed] [Google Scholar]
  50. Rohmann S., Erbel R., Darius H., Görge G., Makowski T., Zotz R., Mohr-Kahaly S., Nixdorff U., Drexler M., Meyer J. Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size. J Am Soc Echocardiogr. 1991 Sep-Oct;4(5):465–474. doi: 10.1016/s0894-7317(14)80380-5. [DOI] [PubMed] [Google Scholar]
  51. Rohmann S., Seifert T., Erbel R., Jakob H., Mohr-Kahaly S., Makowski T., Görge G., Oelert H., Meyer J. Identification of abscess formation in native-valve infective endocarditis using transesophageal echocardiography: implications for surgical treatment. Thorac Cardiovasc Surg. 1991 Oct;39(5):273–280. doi: 10.1055/s-2007-1019985. [DOI] [PubMed] [Google Scholar]
  52. Roy P., Tajik A. J., Giuliani E. R., Schattenberg T. T., Gau G. T., Frye R. L. Spectrum of echocardiographic findings in bacterial endocarditis. Circulation. 1976 Mar;53(3):474–482. doi: 10.1161/01.cir.53.3.474. [DOI] [PubMed] [Google Scholar]
  53. Saner H. E., Asinger R. W., Homans D. C., Helseth H. K., Elsperger K. J. Two-dimensional echocardiographic identification of complicated aortic root endocarditis: implications for surgery. J Am Coll Cardiol. 1987 Oct;10(4):859–868. doi: 10.1016/s0735-1097(87)80281-4. [DOI] [PubMed] [Google Scholar]
  54. Sanfilippo A. J., Picard M. H., Newell J. B., Rosas E., Davidoff R., Thomas J. D., Weyman A. E. Echocardiographic assessment of patients with infectious endocarditis: prediction of risk for complications. J Am Coll Cardiol. 1991 Nov 1;18(5):1191–1199. doi: 10.1016/0735-1097(91)90535-h. [DOI] [PubMed] [Google Scholar]
  55. 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]
  56. Schlüter M., Hinrichs A., Thier W., Kremer P., Schröder S., Cahalan M. K., Hanrath P. Transesophageal two-dimensional echocardiography: comparison of ultrasonic and anatomic sections. Am J Cardiol. 1984 Apr 1;53(8):1173–1178. doi: 10.1016/0002-9149(84)90657-x. [DOI] [PubMed] [Google Scholar]
  57. Schlüter M., Langenstein B. A., Polster J., Kremer P., Souquet J., Engel S., Hanrath P. Transoesophageal cross-sectional echocardiography with a phased array transducer system. Technique and initial clinical results. Br Heart J. 1982 Jul;48(1):67–72. doi: 10.1136/hrt.48.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Seward J. B., Khandheria B. K., Freeman W. K., Oh J. K., Enriquez-Sarano M., Miller F. A., Edwards W. D., Tajik A. J. Multiplane transesophageal echocardiography: image orientation, examination technique, anatomic correlations, and clinical applications. Mayo Clin Proc. 1993 Jun;68(6):523–551. doi: 10.1016/s0025-6196(12)60367-x. [DOI] [PubMed] [Google Scholar]
  59. Shapiro S. M., Young E., Ginzton L. E., Bayer A. S. Pulmonic valve endocarditis as an underdiagnosed disease: role of transesophageal echocardiography. J Am Soc Echocardiogr. 1992 Jan-Feb;5(1):48–51. doi: 10.1016/s0894-7317(14)80102-8. [DOI] [PubMed] [Google Scholar]
  60. Sheikh M. U., Covarrubias E. A., Ali N., Lee W. R., Sheikh N. M., Roberts W. C. M-mode echocardiographic observations during and after healing of active bacterial endocarditis limited to the mitral valve. Am Heart J. 1981 Jan;101(1):37–45. doi: 10.1016/0002-8703(81)90381-1. [DOI] [PubMed] [Google Scholar]
  61. Shively B. K., Gurule F. T., Roldan C. A., Leggett J. H., Schiller N. B. Diagnostic value of transesophageal compared with transthoracic echocardiography in infective endocarditis. J Am Coll Cardiol. 1991 Aug;18(2):391–397. doi: 10.1016/0735-1097(91)90591-v. [DOI] [PubMed] [Google Scholar]
  62. Shively B. K. Transesophageal echocardiography in endocarditis. Cardiol Clin. 1993 Aug;11(3):437–446. [PubMed] [Google Scholar]
  63. Sochowski R. A., Chan K. L. Implication of negative results on a monoplane transesophageal echocardiographic study in patients with suspected infective endocarditis. J Am Coll Cardiol. 1993 Jan;21(1):216–221. doi: 10.1016/0735-1097(93)90739-n. [DOI] [PubMed] [Google Scholar]
  64. Stafford W. J., Petch J., Radford D. J. Vegetations in infective endocarditis. Clinical relevance and diagnosis by cross sectional echocardiography. Br Heart J. 1985 Mar;53(3):310–313. doi: 10.1136/hrt.53.3.310. [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Steckelberg J. M., Khandheria B. K., Anhalt J. P., Ballard D. J., Seward J. B., Click R. L., Wilson W. R. Prospective evaluation of the risk of bacteremia associated with transesophageal echocardiography. Circulation. 1991 Jul;84(1):177–180. doi: 10.1161/01.cir.84.1.177. [DOI] [PubMed] [Google Scholar]
  66. Steckelberg J. M., Murphy J. G., Ballard D., Bailey K., Tajik A. J., Taliercio C. P., Giuliani E. R., Wilson W. R. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med. 1991 Apr 15;114(8):635–640. doi: 10.7326/0003-4819-114-8-635. [DOI] [PubMed] [Google Scholar]
  67. 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]
  68. Taams M. A., Gussenhoven E. J., Bos E., de Jaegere P., Roelandt J. R., Sutherland G. R., Bom N. Enhanced morphological diagnosis in infective endocarditis by transoesophageal echocardiography. Br Heart J. 1990 Feb;63(2):109–113. doi: 10.1136/hrt.63.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Von Reyn C. F., Levy B. S., Arbeit R. D., Friedland G., Crumpacker C. S. Infective endocarditis: an analysis based on strict case definitions. Ann Intern Med. 1981 Apr;94(4 Pt 1):505–518. doi: 10.7326/0003-4819-94-4-505. [DOI] [PubMed] [Google Scholar]
  70. Wann L. S., Dillon J. C., Weyman A. E., Feigenbaum H. Echocardiography in bacterial endocarditis. N Engl J Med. 1976 Jul 15;295(3):135–139. doi: 10.1056/NEJM197607152950304. [DOI] [PubMed] [Google Scholar]
  71. Wann L. S., Hallam C. C., Dillon J. C., Weyman A. E., Feigenbaum H. Comparison of M-mode and cross-sectional echocardiography in infective endocarditis. Circulation. 1979 Oct;60(4):728–733. doi: 10.1161/01.cir.60.4.728. [DOI] [PubMed] [Google Scholar]
  72. Weinstein L. Life-threatening complications of infective endocarditis and their management. Arch Intern Med. 1986 May;146(5):953–957. [PubMed] [Google Scholar]
  73. Winslow T., Foster E., Adams J. R., Schiller N. B. Pulmonary valve endocarditis: improved diagnosis with biplane transesophageal echocardiography. J Am Soc Echocardiogr. 1992 Mar-Apr;5(2):206–210. doi: 10.1016/s0894-7317(14)80556-7. [DOI] [PubMed] [Google Scholar]
  74. Yvorchuk K. J., Chan K. L. Application of transthoracic and transesophageal echocardiography in the diagnosis and management of infective endocarditis. J Am Soc Echocardiogr. 1994 May-Jun;7(3 Pt 1):294–308. doi: 10.1016/s0894-7317(14)80400-8. [DOI] [PubMed] [Google Scholar]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute

RESOURCES