[Value of 2-dimensional echocardiography in the diagnosis of infectious endocarditis]

Cross sectional and simultaneous M-mode echocardiograms were performed on 15 consecutive patients with infective endocarditis, 14 of whom had pre-existing cardiac lesions. Patients were divided into two groups based on the presence or absence of echocardiographically detected vegetative lesions. In 10 out of 15 patients vegetations were present (66%): aortic valve 5, mitral valve 1, tricuspid valve 1, both aortic and mitral valves 1 and left ventricular endocardium associated with aortic valve lesion 2. In this group 3 had systemic embolic episodes and 2 died, whereas none of the 5 patients without detectable vegetations had complications. In 6 the preoperative echocardiographic findings could be confirmed at surgery or autopsy. Emergency surgery without catheterization was performed in 2 patients. Two dimensional echocardiography provides an important non invasive method of assessing a significant percentage of vegetations, but a negative echocardiogram does not exclude infective endocarditis. From the present experience and that of others the detection of vegetations by echocardiography identifies a subgroup of patients with a higher risk for complications in whom early operative intervention without catheterization can be performed. Cross sectional echocardiography may also prove helpful for serial examination of valve vegetations.