Transesophageal echocardiography (TEE) in the evaluation of infective endocarditis

Echocardiography is an essential tool for the modern diagnosis and management of infective endocarditis and its complications. The negative predictive value of surface imaging is inadequate to rule out endocarditis in most instances; diagnostic sensitivity is improved by way of the transesophageal approach. The clinical scenario and pretest probability of disease should guide the use of transesophageal versus transthoracic imaging. Those at high risk for endocarditis or its complications in particular should undergo early TEE. Serial studies may be required to guide management. In the setting of an initially negative echocardiographic study, a repeat examination is indicated if the clinical suspicion of endocarditis persists or if the clinical picture changes. Combined transthoracic echocardiography and TEE may supply complementary information useful in management and follow-up. As most published research predates recent advances in imaging, the impact of changing technology, such as harmonic and three-dimensional imaging, in the management of endocarditis is yet to be determined.