[Outcome of echocardiographic vegetations in bacterial endocarditis during and after anti-infective therapy]

Echocardiography is a practical and reliable method of detecting endocardial vegetations. The aim of this study was to assess the course of echocardiographic vegetations in bacterial endocarditis under anti infectious therapy and to assess the prognostic significance of the vegetations. Twenty four patients with echocardiographic signs of vegetations were included in a standardised protocol: M mode and 2D examination at the beginning and at the end of medical treatment and when possible after bacteriological cure (average period of follow-up 16 +/- 6 weeks). Special attention was paid to the volume (assessed I to III) and acoustic density of the vegetations. Fifteen patients underwent surgery (62.5%). The size of the vegetations did not differ significantly from that observed in the other patients. The size of the vegetations remained constant during medical therapy and after bacteriological cure in 2/3 of cases. The vegetations grew during medical therapy (even when the patients were apyrexic) in 29% of cases, and even after a 40 day course of anti infectious therapy in 2 cases. The size of the vegetations decreases in 3 cases during treatment (2 cases of embolisation) and in 2 cases after bacteriological cure (without embolisation). No correlations could be drawn between the acoustic density of the vegetations and the outcome. In conclusion, the presence of a large vegetation in bacterial endocarditis does not in itself mean a poor prognosis. However, these large vegetations are often associated with severe mutilating lesions (62.5% in our series). The size of the vegetations remained unchanged during and after medical treatment in two thirds of cases.