Echography and phonography of acute aortic regurgitation in bacterial endocarditis

Since management of acute aortic regurgitation in bacterial endocarditis is enhanced by early recognition, echocardiography and phonocardiography were evaluated in three such cases documented by catheterization and surgery without positive blood cultures and compared to echophonograms of 34 patients with aortic regurgitation of other origins. Endocarditis manifested distinctive, thickened, irregular aortic leaflet echoes with normal systolic excursion and mitral echopreclosure with anterior leaflet fluttering. Mitral preclosure resulted in mid- or end-diastolic crescendo murmur accompanied by soft first heart sound. Aortic echograms in nonendocarditis showed either widened root, diminished leaflet excursion, absence of irregular valvular thickening, or normal leaflets, all without mitral preclosure. This study shows specific echophonographic findings of aortic regurgitation due to endocarditis that enable diagnosis of this condition in the absence of positive blood cultures.