The diagnosis of prosthetic valve endocarditis by echocardiography

Echocardiography, using the standard transthoracic and transesophageal (TEE) approaches, has been shown to be a useful tool in the diagnosis and management of patients with prosthetic valve endocarditis (PVE). The role of echocardiography involves (1) finding evidence for vegetations, (2) characterizing valvular dysfunction, (3) identifying periprosthetic spread of infection, and (4) determining preoperative prognostic data that impact on the need and timing of surgical intervention. Incorporation of echocardiography into the diagnostic criteria for endocarditis prevents delay in management and costly errors, particularly in patients with culture-negative infections and complications of the infection including jet lesions and deep tissue infections of the heart. TEE is particularly helpful in PVE, because shielding by the prosthesis may prevent adequate transthoracic imaging, which give false-negative results. With the aid of intraoperative TEE, the surgical mission should be to extirpate all the infection and reconstruct the heart with as little prosthetic material as possible. Transthoracic echocardiography is also useful in the follow-up management of patients with PVE.