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

研究成果: 雜誌貢獻文章同行評審

16 引文 斯高帕斯(Scopus)

摘要

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.
原文英語
頁(從 - 到)250-257
頁數8
期刊Cardiology (Switzerland)
83
發行號4
DOIs
出版狀態已發佈 - 一月 1 1993
對外發佈

ASJC Scopus subject areas

  • 心臟病學與心血管醫學
  • 藥學(醫學)

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