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 important to his treatment: an aortic root abscess and torn aortic valve leaflet (Fig 1). Of the remaining 14 patients who did not on subsequent follow-up demonstrate evidence for infectious endocarditis, transesophageal echocardiography demonstrated no falsely abnormal findings.
We therefore found transthoracic echocardiography to demonstrate a sensitivity of 50 percent, specificity of 93 percent, and a positive predictive value of 83 percent. These values for transthoracic echocardiography are similar to those reported by others. Transesophageal echocardiography yielded a sensitivity, specificity, and predictive value of 100 percent. Buy Advair Diskus Online
This study shows that transesophageal echocardiography is able to demonstrate vegetations with a substantially higher sensitivity than conventional transthoracic echocardiography. In agreement with other authors, we found this to be a function of several factors, including poor transthoracic image quality in some patients, vegetation size, and interposition of a prosthetic valve between the vegetation and transducer.