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ECHOCARDIOGRAPHIC

EVALUATION OF ENDOCARDIAL

DISEASES

PRESENTERS:CHARITY.M COLLINS.N CHAIRPERSON;STEPHEN.O-CLINICAL CARDIOLOGY

European Journal of Echocardiography 2010; 11: 202- 219

European Heart Journal 2009;30:2369- 2413 Eur J Echocardiogr 2010;11:202- 219

Echocardiographic criteria

for IE

• (^) Vegetations
  • (^) Hallmark lesion of IE
• (^) Abscess and perivalvular involvement - (^) Aortic valve and prosthetic valve: more frequent - (^) Perivalvular complications: pseudoaneurysm and fistulization
• (^) New dehiscence of a prosthetic valve Eur J Echocardiogr 2010;11:202- 219

Limitations and Pitfalls of Echo

for Diagnosis of IE

1. Both the sensitivity and specificity of TTE and TEE are not 100%.
2. A negative echo exam does not rule out IE.
3. Repeat TTE/TEE maybe necessary in some situations.
4. Results of the echo study must interpreted with caution,taking into account the clinical presentation and the likelihood of IE.

Echocardiography is not 100% sensitive for the diagnosis of infective endocarditis

• (^) A negative echocardiogram may be observed in about 15% of infective endocarditis.
• (^) The most frequent explanations :
  • (^) Very small vegetations
  • (^) Difficulties in identifying vegetations in the presence of pre- existing severe lesions.( mitral valve prolapse, degeneration lesions, and prosthetic valves)
  • (^) When vegetations are non-oscillating and/or atypically located.
  • (^) At the very early stage of the disease
  • (^) When vegetations are not yet present or too small to be identified.
• (^) A repeat examination has to be performed 7- 10 days after the 1 st examination in case of high level of clinical suspicion or even earlier when justified by clinical presentation. Eur J Echocardiogr 2010;11:202- 219

Eur J Echocardiogr 2010;11:202- 219

Indications and timing of

surgery in IE

• (^) Heart failure
  • (^) The most frequent indication: 40-60% of IE
  • (^) Acute regurgitation
• (^) Uncontrolled infection
  • (^) Abscess, pseudoaneurysm and fistula
• (^) Preventive of embolism
  • (^) Vegetations > 10mm : high risk of embolism (^) Eur J Echocardiogr 2010;11:202- 219

Echo findings suggestive of

early surgery for IE with

heart failure

• (^) Extensive obstructive valve lesions
• (^) Massive regurgitation
• (^) Associated abscess and pseudoaneurysm

Vegetation and pseudoaneurysm fistul a absces s

Evolution of anterior aortic

bioprosthetic abscess

Echo vs Anatomy

Eur J Echocardiogr 2010;11:202- 219

Prognosis Assessment at

Admission

• (^) Perivalvular complications
• (^) Severe native or prosthetic regurgitation or obstruction
• (^) Low LVEF
• (^) Pulmonary hypertension
• (^) Large vegetations
• (^) Premature mitral valve closure or other signs of elevated diastolic pressures The above echo findings have been associated with a worse prognosis of IE.

Echo follow up under

therapy

• (^) Echo must be used to follow up of patients with IE under antibiotic therapy
• (^) The number, type and timing of repeated exams depend on - (^) The clinical presentation - (^) The type of organisms - (^) The initial echographic findings
• (^) Weekly TTE for non-complicated streptococcal native IE
• (^) More frequent TTE and TEE for post-op staphylococcal early PVE