Echocardiography in the management of infectious endocarditis

Infectious endocarditis is a common and serious condition which affects nea rly 1300 people per year in France. In 1/3 of cases, it occurs without unde rlying cardiac disease. A recrudescence of special clinical forms of infect ious endocarditis is observed nowadays: endocarditis in the intensive care unit, endocarditis of prosthetic valves and on transvenous pacing leads. Ir respective of the clinical form, early diagnosis is essential in the manage ment and for the prognosis. The association of echocardiographic criteria t o the usual clinical criteria of endocarditis provides a better means of di agnosis. Transthoracic and transoesophageal echocardiography are complementary for t he diagnosis of the elemental lesion: the vegetation. Transoesophageal is m ore sensitive than transthoracic echocardiography: 100% versus 60%. Transth oracic echocardiography may be adequate for investigation of low risk popul ations, but only transoesophageal echocardiography provides a complete inve stigation of infectious lesions : valvular perforation, abscess, fistula. T he haemodynamic consequences of valvular lesions may be assessed and follow -up established by echocardiography, thereby identifying high risk patients for morbidity and mortality. Therefore, refractory cardiac failure, a larg e vegetation of the mitral valve and abscess formation usually result in su rgical referral. Echocardiography in both modalities is essential for the optimal management of infectious endocarditis.