The Role of Echocardiography in the Diagnosis and Management of Infective Endocarditis

SUMMARY The echocardiographic appearance in suspected endocarditis must always be interpreted in the context of the clinical findings. Thus although echocardiography may contribute to the early diagnosis of infective endocarditis, it should rarely be used as a screening test. It is highly sensitive for the detection of complications such as abscesses or valvular regurgitation and can estimate their severity. Although transthoracic imaging will allow a complete study in many cases, the transoesophageal approach is superior for the detection of abscesses and the assessment of prosthetic mitral valves. Patients with large vegetations, particularly on the mitral valve, are at increased risk of embolism but there is no convincing evidence to support prophylactic surgery in these cases.