A case of infective endocarditis diagnosed by transesophageal but not transthoracic echocardiography

Abstract

abscess cavities, excision of necrotic tissue, and the closure of fistulous tracts are performed [4]. Aortic valve replacement is carried out if the abscesses spread through the aortic valve. In this case, even though preoperative TTE failed to reveal mobile vegetation, intraoperative TEE revealed mobile vegetation and perivalvular abscesses. Therefore, mitral valve replacement, drainage of abscess cavities, and excision of necrotic tissue were recommended. Several studies have reported that TEE has a substantially higher sensitivity and specificity than TTE for detecting vegetation, perivalvular extensions of IE, and the presence of a myocardial abscess [5–7]. As prosthetic structures are strongly echogenic, they may prevent vegetation detection [8]. In a large series of prosthetic endocarditis, TEE has shown an 86%–94% sensitivity and an 88%–100% specificity for vegetation diagnosis, while TTE sensitivity was only 36%–69% [9]. TEE is a useful tool for the diagnosis of IE after mitral valve plasty and surgical decision making.