Echocardiography is commonly accepted as the method of choice for the non-invasive diagnosis of vegetations and other lesions associated with infective endocarditis

Study aim: To assess the accuracy of echocardiography in the overall diagnosis of the morphological cardiac lesions we retrospectively analyzed and compared the preoperative echocardiographic data with the surgical findings of 95 adult patients operated for infective endocarditis

Patients and methods: During the last ten years (junnary 2001 and november 2006) 95 patients were operated in our institution during the acute phase of bacterial infective endocarditis, the echocardiographic findings were retrospectively compared and contrasted with direct surgical inspection

We analysed recognition of vegetations, abscess, pseudoaneurysm, fistula, cusp rupture. And Prosthetic leak.

Results: Infective endocarditis was on native valve in 78 patients and on prosthetic valve in 17 patients.

Transthoracic echocardiography (TTE) was used in 92 cases (77 with native and 15 with prosthetic valves), both TTE and transesophageal echocardiography (TEE) in 70 (59 with native and 11 with prosthetic valves) and only TEE in 2 patients who underwent emergency surgery. The echocardiographic diagnosis was correct in all the cases, but incomplete in 9 cases.

Vegetations were detected in 67 cases (55 on native valve and 12 on prosthetic valves), complications were detected at operation in 37 cases, perivalvular abcess in 19 patients, perforation of the valvular leaflets in 8. Prosthetic leak in 7, pseudoaneurysm in 1 case and fistula in 2.

Sensitivity of TTE in recognition of abscesses was 65 % in TTE, 80 % in TEE, in perforation of the valvular leaflet detection, TTE: 67 %, TEE: 87 % ; in fistula detection TTE: 50 %, TEE: 100 % ; in prosthetic leak TTE: 66 %, TEE: 89 %.

There were no differences between aortic or mitral valves (5/44 vs 5/34 ; p = ns), native or prosthetic (6/78 vs 3/17 ; p = ns).

Conclusion: An echocardiographic study should be repeated just before any surgical procedures in patients with active, both echocardiographic methods have some inherent limitations while diagnosing complications of infective endocarditis. In particular, these include small abscesses and cusp rupture. Using both modalities in a complementary way seems to offer the best approach in overall definition of the extent of inflammation.