Infective endocarditis treated surgically: correlation between imaging, and surgical findings

Area of Science:

• Cardiology
• Infectious Diseases
• Surgical Pathology

Background:

• Infectious endocarditis (IE) diagnosis heavily relies on echocardiography.
• Transesophageal echocardiography (TEE) is a key imaging modality for IE.
• Understanding the concordance between TEE and surgical findings is crucial for patient management.

Purpose of the Study:

• To assess the correlation between transesophageal echocardiography (TEE) and surgical findings in patients with infectious endocarditis (IE).
• To identify factors associated with discrepancies between TEE and surgical findings.
• To evaluate the clinical impact of these discrepancies on surgical appropriateness.

Main Methods:

• Retrospective study of 80 IE patients who underwent surgery.
• Comparison of TEE findings (vegetations, abscesses, valve involvement, vegetation size) with intraoperative surgical findings.
• Definition of discrepancies as ≥1 infected valve, abscess, or vegetation size ≥5 mm.
• Descriptive statistics and regression analysis were employed.

Main Results:

• High correlation observed between TEE and surgical findings for abscess count, valve involvement, and vegetation size.
• More vegetations were identified during surgery (19%) compared to TEE (11%).
• Discrepancies occurred in 42.5% of patients, associated with S. viridans infection and mitral valve involvement.
• Charlson index and vegetation size were linked to discordant findings in multivariate analysis.

Conclusions:

• TEE is a reliable tool for assessing infectious endocarditis, showing strong correlation with surgical findings.
• Discrepancies exist, particularly in cases of S. viridans IE or mitral valve involvement, but do not compromise surgical decision-making.
• Despite minor differences, TEE findings guide appropriate surgical intervention for IE.