[Transesophageal echocardiography in infectious endocarditis]

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• Transthoracic echocardiography (TTE) is a primary tool for diagnosing and evaluating infective endocarditis (IE) prognosis.
• TTE limitations include its non-histobacteriological nature and operator dependency.
• Identifying high-risk patients with large vegetations, severe valve damage, or complications like abscesses is critical for timely intervention.

Purpose of the Study:

• To highlight the evolving role of TTE in infective endocarditis management.
• To define the specific indications for transesophageal echocardiography (TEE) in IE.
• To emphasize the importance of echocardiography in assessing IE complications and guiding surgical decisions.

Main Methods:

• Review of the diagnostic and prognostic utility of TTE in infective endocarditis over the past 20 years.
• Analysis of TEE's role in refining TTE findings and managing complex IE cases.
• Identification of clinical scenarios necessitating TEE, including negative TTE, severe infections, and prosthetic valve endocarditis.

Main Results:

• TTE effectively detects high-risk patients with features like large vegetations and severe valve leaks.
• TEE provides enhanced precision and completeness of diagnostic information compared to TTE.
• Vegetation size is a significant risk factor for morbidity and mortality, particularly embolism.

Conclusions:

• TTE is indispensable for IE diagnosis and risk stratification, guiding emergency surgery when needed.
• TEE is essential for confirming IE when TTE is negative, monitoring severe cases, and evaluating prosthetic valve endocarditis.
• Echocardiographic assessment, particularly TEE, is vital for optimizing patient management and surgical intervention in IE.