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Echocardiography in infective endocarditis
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  1. A Evangelista,
  2. M T Gonzalez-Alujas
  1. Servicio de Cardiologia, Hospital Vall d’ Hebron, Barcelona, Spain
  1. Correspondence to:
    Dr A Evangelista
    Servicio de Cardiologia, Hospital Vall d’ Hebron, P° Vall d’ Hebron 119-129, 08035 Barcelona. Spain; evangelhg.vhebron.es

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Since Dillon and colleagues1 in 1973 described valvar vegetations by M mode echocardiography, the technique has assumed an increasingly important role in the assessment and management of endocarditis. The development of two dimensional and later transoesophageal echocardiography (TOE) has significantly improved the non-invasive detection of vegetations. Moreover, echo-Doppler studies provide clinically important information on the presence and degree of valvar destruction and their haemodynamic consequences, as well as on the existence of perivalvar infection. The diagnostic strategy proposed by Durack and colleagues2 (the Duke criteria) combined echocardiographic findings with clinical and microbiological data. Three echocardiographic findings were considered to be major criteria for the diagnosis of endocarditis: (1) presence of vegetations defined as mobile echodense masses implanted in a valve or mural endocardium in the trajectory of a regurgitant jet or implanted in prosthetic material with no alternative anatomical explanation; (2) presence of abscesses; or (3) presence of a new dehiscence of a valvar prosthesis. Abnormal echocardiographic findings not fulfilling those definitions were considered minor criteria. More recently the use of TOE has resulted in better imaging and therefore doubtful findings are not considered minor criteria any longer.3 Since the definite diagnosis of endocarditis requires the presence of two major criteria, or one major and three minor criteria, it is clear that echocardiography has assumed a crucial role in the diagnosis of the disease, particularly when blood cultures are negative.

DETECTION OF VEGETATIONS

There is no better technique for non-invasive visualisation of vegetations than echocardiography (fig 1). Overall the detection rate for vegetations by transthoracic echocardiography (TTE) in patients with a clinical suspicion of endocarditis averages around 50%.4 The diagnostic yield of the technique in the detection of vegetations is influenced by several factors: image quality; echogenicity and vegetation size; vegetation location; presence of previous valvar disease or valvar …

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    BMJ Publishing Group Ltd and British Cardiovascular Society