Endocarditis: Clinical outcome and benefit of trans-oesophageal echocardiography

The improved prognosis for infective endocarditis (IE) seen in the last dec ade is due partly to more active surgical treatment and partly to improved diagnosis by echocardiography, To evaluate the clinical value of repeated t rans-oesophageal echocardiography (TEE) 34 patients with 35 episodes of sus pected LE were included in a prospective part of the study (group A), TEE w as carried out for diagnosis, at discharge and about 5 months after hospita lization. Endocarditis was classified using Duke's criteria. In a retrospec tive part of the study 32 other patients with 34 episodes of IE mere includ ed (group B). Both groups were analysed regarding mortality, frequency of s urgery and classification according to Duke. The diagnosis was regarded as definite in 49 and possible in 20 episodes. Vegetation-size decreased signi ficantly (p < 0.001) during treatment. In contrast, no significant changes in valvular insufficiency were found. In episodes diagnosed as definite, th e mortality was 2/49 (4.1%). The low mortality might be explained by the hi gh frequency of surgery (22%), the inclusion of patients with right-sided I E, and 'early diagnosis'. The first TEE was important for correct diagnosis in patients with small vegetations and for those needing surgery. The clin ical value of the additional investigations was low in native valve endocar ditis.