Value of Transesophageal Echocardiography as an Adjunct to Transthoracic Echocardiography in Evaluation of Native and Prosthetic Valve Endocarditis (7)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 graded as poor, and a St. Jude prosthesis in the mitral position in patient 10 hindered transthoracic evaluation. birth control yasmin
In all seven patients who underwent either surgery or autopsy, the abnormal transesophageal echocardiography findings were confirmed and were not misinterpretations. There were no new findings of significance that had not been appreciated by transesophageal echocardiography.
There was no significant difference in the degree of valvular insufficiency as quantitated by transthoracic and transesophageal echocardiography in the endocarditis group. Two patients with endocarditis had moderate to severe mitral insufficiency (patients 4 and 5, Table 1) and one patient demonstrated severe aortic insufficiency (patient 1, lable 1). Again there was no difference in the severity of valvular insufficiency in these three patients when transthoracic techniques were compared with transesophageal techniques. The remaining patients with endocarditis had no more than mild valvular insufficiency.
Fourteen patients had normal transesophageal examinations, all of whom were believed not to have infectious endocarditis after follow-up. All 14 demonstrated an alternative cause for their clinical presentation (Table 2).


Figure 3. Expanded transesophageal four-chamber view demonstrating two small vegetations (0.6 cm2) on a St. Jude Medical mechanical prosthesis (MV PROST) (arrows), not suspected by transthoracic echocardiography. LA = left atrium; LV=left ventricle; MV = mitral valve; and RA = right atrium.