Limited reliability of the "negative" two-dimensional echocardiogram in the evaluation of infectious vegetative...

Three patients with vegetative endocarditis involving a native valve, a mechanical prosthesis and a bioprosthetic valve respectively are presented. Each underwent emergency surgical exploration and prosthetic valve replacement based on clinical evidence of vegetative endocarditis after an initial delay following a report of a negative two-dimensional echocardiographic study. These cases emphasize the fact that within the clinical setting in which vegetative endocarditis is strongly suspected a negative two-dimensional echocardiographic study must be interpreted with caution. This is particularly true in patients with fungal, embolic or prosthetic valvular endocarditis. A decision to delay surgical consultation and therapy based upon a negative two-dimensional echocardiographic study in these patients is ill advised and may result in serious thromboembolic complications or even death.