DIAGNOSTIC-CRITERIA OF INFECTIOUS ENDOCAR DITIS FROM VON-REYN TO DUKECRITERIA - TRANSTHORACIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY

The Von Reyn criteria determine only a small number of definitive diag noses of infectious endocarditis, while it is mainly diagnosed by hist opathological confirmation in surgery or autopsy. This necessitates ca rrying out a new diagnostic scheme with accurate sensitivity and speci ficity based on rigorous clinical support. This scheme is provided by the Duke University criteria, which enhance the role of conventional a nd transesophageal echocardiography, in the diagnosis of infectious en docarditis. Echocardiography is the only accurate procedure for a non invasive diagnosis of vegetation, the main lesion in this pathology. O ften, tissue destruction causes regurgitation, which is responsible fo r hemodynamic impairment or allows the spread of the infectious proces s to perivalvular tissue and can form an abscess. These complications and many others, which are difficult to treat, require an early diagno sis of this disease. Sensitivity of transesophageal technique to detec t vegetations and complications is higher than that observed in conven tional echocardiography, above all in patients with prosthetic valves. If the transesophageal study is negative, the existence of an infecti ous endocarditis is quite unlikely. Nevertheless, we need to consider clinical features, as the specificity of this technique is moderate.