Infective endocarditis in the transesophageal echocardiographic era

Juey Jen Hwang, Kou Gi Shyu, Jin Jer Chen, Yu Lin Ko, Jiunn Lee Lin, Yung Zu Tseng, Peiliang Kuan, Wen Pin Lien

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

During a 45-month period, 50 consecutive patients with infective endocarditis were evaluated at the National Taiwan University Hospital with emphasis on the role of transesophageal echocardiography (TEE) in the management of these patients. Among them, rheumatic heart disease was still the most common underlying cardiac disorder (10/50, 20%), while mitral valve prolapse (8/50, 16%) and congenital heart disease (8/50, 16%) were also frequently encountered. More than one third (19/50, 38%) had no underlying heart disease. Four intravenous drug abusers, quite rare previously in Taiwan, were found during the study period. Native valves involved were mostly mitral valve (n = 18), aortic valve (n = 15), and both mitral and aortic valves (n = 3). Tricuspid valve and pulmonic valve were involved in 3 and 2 patients, respectively. Streptococcus viridans was the leading microorganism isolated (21/50, 42%). Staphylococci and enterococci were found in 9 (18%) and 5 (10%) patients, respectively. Twelve patients (24%) were culture-negative in this series. Embolic complications occurred in 13 patients (26%), with a total of 17 episodes. No significant correlation was found between the occurrence of embolization and the vegetation size or the location of the vegetation, if patients with right-sided valvular vegetation and no identifiable vegetation were excluded. Surgery was needed by 25 patients (50%), and mortality occurred in 6 (12%). TEE was superior to transthoracic echocardiography in the detection of vegetations at the mitral or prosthetic valves. Concerning the associated complications with infective endocarditis, TEE was also superior in estimating the severity of mitral regurgitation, recognizing ruptured chordae tendineae and detecting subaortic complications such as valve ring abscess and mitral valve perforation. In conclusion, TEE is a highly valuable adjunct to other diagnostic tools in certain cases of suspected infective endocarditis or with a complicated clinical course. Awareness of the changing spectrum of underlying heart disease and a proper diagnostic approach will make clinicians more alert to early detection of infective endocarditis in the new era.

Original languageEnglish
Pages (from-to)250-257
Number of pages8
JournalCardiology (Switzerland)
Volume83
Issue number4
DOIs
Publication statusPublished - Jan 1 1993
Externally publishedYes

Fingerprint

Endocarditis
Transesophageal Echocardiography
Mitral Valve
Heart Diseases
Aortic Valve
Taiwan
Chordae Tendineae
Viridans Streptococci
Rheumatic Heart Disease
Mitral Valve Prolapse
Tricuspid Valve
Enterococcus
Mitral Valve Insufficiency
Patient Rights
Drug Users
Staphylococcus
Abscess
Echocardiography
Lung
Mortality

Keywords

  • Infective endocarditis
  • Transesophageal echocardiography
  • Transthoracic echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Hwang, J. J., Shyu, K. G., Chen, J. J., Ko, Y. L., Lin, J. L., Tseng, Y. Z., ... Lien, W. P. (1993). Infective endocarditis in the transesophageal echocardiographic era. Cardiology (Switzerland), 83(4), 250-257. https://doi.org/10.1159/000175978

Infective endocarditis in the transesophageal echocardiographic era. / Hwang, Juey Jen; Shyu, Kou Gi; Chen, Jin Jer; Ko, Yu Lin; Lin, Jiunn Lee; Tseng, Yung Zu; Kuan, Peiliang; Lien, Wen Pin.

In: Cardiology (Switzerland), Vol. 83, No. 4, 01.01.1993, p. 250-257.

Research output: Contribution to journalArticle

Hwang, JJ, Shyu, KG, Chen, JJ, Ko, YL, Lin, JL, Tseng, YZ, Kuan, P & Lien, WP 1993, 'Infective endocarditis in the transesophageal echocardiographic era', Cardiology (Switzerland), vol. 83, no. 4, pp. 250-257. https://doi.org/10.1159/000175978
Hwang, Juey Jen ; Shyu, Kou Gi ; Chen, Jin Jer ; Ko, Yu Lin ; Lin, Jiunn Lee ; Tseng, Yung Zu ; Kuan, Peiliang ; Lien, Wen Pin. / Infective endocarditis in the transesophageal echocardiographic era. In: Cardiology (Switzerland). 1993 ; Vol. 83, No. 4. pp. 250-257.
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