Chest
Volume 102, Issue 6, December 1992, Pages 1886-1888
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Selected Reports
Utility of Transesophageal Echocardiography in the Conservative Management of Prosthetic Valve Endocarditis

https://doi.org/10.1378/chest.102.6.1886Get rights and content

Prosthetic valve endocarditis is a formidable complication following cardiac valve replacement. Surgical intervention has resulted in a significant reduction in mortality when certain complications prevail. We report two such cases of prosthetic valve endocarditis in which the use of transesophageal echocardiography permitted close surveillance during medical therapy and thus avoided the need for surgical intervention. Therefore, with the improved ability to monitor disease progression with transesophageal echocardiography, nonsurgical management of prosthetic valve endocarditis remains an option.

Section snippets

Case 1

A 33-year-old male intravenous drug abuser, with a St. Jude mitral valve replacement, was admitted to the hospital with headache, lethargy, abdominal pain, and fever. Examination revealed a fever of 39.5°C, heart rate of 100/min, blood pressure of 110/70 mm Hg, a crisp valve click, a 1/6 systolic ejection murmur, hepatosplenomegaly, and embolic lesions on the right great toe. The patient was HIV positive with a WBC count of 21.7 × 103/cu mm. Chest roentgenogram was normal and the

Discussion

Despite the belief by some that patients with mechanical PVE should undergo operation as soon as the diagnosis has been established,2 we have documented the successful medical management of this condition. The enhanced ability to evaluate and monitor mechanical prostheses and adjacent endocardial structures during and following active infection provides greater latitude in determining the need for, and timing of, surgical intervention.

Echocardiography is the noninvasive imaging diagnostic

ACKNOWLEDGMENT

Dr. Arthur Chernoff and Dr. Harry Goldberg provided clinical information.

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This study was supported in part by the Women's League for Medical Research.

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