Transesophageal Echocardiography

Clinical Implications Early identification of vegetations or abscesses in patients with infectious endocarditis by transesophageal echocardiography may lead to a better prognosis. Initiation of appropriate therapy earlier in the course of the disease may decrease both morbidity and mortality by preventing valvular or adjacent structural damage, systemic embolic events, or overwhelming sepsis. buy birth control […]

Because our cohort demonstrated relatively strong clinical evidence of infectious endocarditis, in particular the presence of positive blood cultures, they had a higher pretest probability for the presence of vegetations. This would be expected to yield a higher echocardiographic sensitivity as demonstrated by other investigators.

The esophagus provides a convenient conduit for a transducer to be placed in close juxtaposition to the heart. This allows for better visualization of cardiac structures because of less structural interference from lung parenchyma, adipose and breast tissue, pathologic conditions such as chronic obstructive pulmonary disease and chest wall deformities, or prosthetic valves that impair […]

However, transesophageal echocardiograms in all ten of these patients were abnormal. In eight of these ten patients with endocarditis, there was concordance among all three observers, including the number and location of the lesions present in each patient. Additionally, in one patient with abnormal findings by the transthoracic technique, only transesophageal echocardiography demonstrated ancillary information […]

Discussion Infectious endocarditis carries a significant morbidity and mortality, often as a result of late diagnosis. In its subacute form, early signs and symptoms are generally vague and nonspecific. It is often not until later in the course of the disease that the more suggestive clues occur, such as a new cardiac murmur or embolic […]

In each of these patients, therapy was specifically and successfully directed to the underlying cause. In these patients with documented nonendocarditis bacterial infections (see Table 2), the appropriate course of antibiotics was administered, which in no case exceeded a 7- to 14-day course of antibiotics nor would it have been considered adequate therapy for the […]

Patients 9 and 10 each had two vegetations on their mitral valve leaflets by transesophageal echocardiography, none of which were demonstrated by transthoracic echocardiography. Patient 9 had vegetations that were 1.0 and 0.2 cm2; patient 10 had two vegetations, both 0.6 cm2 (Fig 3). Notably, the quality of the transthoracic study on patient 9 was […]

Patients 2 and 3 each had vegetations on a porcine mitral valve prosthesis that were visualized by transesophageal but not transthoracic echocardiography. Patient 4, with all native valves, had a 3-cm2 vegetation on the tricuspid valve that was seen on both transthoracic and transesophageal echocardiography. However, there was also a 0.25-cm2 mass on the mitral […]

Results Table 1 summarizes the results of ten patients who were determined to have infectious endocarditis. In five patients (patients 1 through 5, Table 1), both transthoracic and transesophageal echocardiograms were abnormal, while the other five patients (patients 6 through 10) had normal transthoracic echocardiograms, but abnormal transesophageal examinations. In four of five patients with […]

Echocardiographic Criteria Echogenic areas adjacent to valvular structures were considered to be vegetations when two of three independently reviewing cardiologists found a mass associated with the valvular apparatus. The masses could be sessile or pedunculated, but must have distinctly extended outward from the surface of the valve or endocardium. An abscess was defined as an […]