We examined 129 standard M-mode echocardiograms obtained in 65 patients (16 to 73 years old) with bacterial endocarditis. Twenty of the 22 patients with vegetations recognizable by echocardiography died, or underwent cardiac operation (mean interval from admission 22 days, and range two to 120 days). Vegetations were seen on the echocardiograms in 22 (aortic 10, mitral nine and tricuspid three, with anatomic confirmation in 19). Of patients without vegetations on echocardiography none underwent emergency operation or died as a result of cardiac disease (mean follow-up period of 14 months, range of two to 38 months). Other echocardiographic findings in those with vegetations included early mitral-valve closure (six), “flail” aortic leaflet (three), and “flail” mitral leaflet (three). Echocardiography can provide a rapid, reliable noninvasive diagnosis of bacterial vegetations in certain patients with bacterial endocarditis and may identify patients with more severe disease who may require operative intervention. (N Engl J Med 295:135139, 1976). Despite modern microbiologic technics and antibiotics, bacterial endocarditis remains a major diagnostic and therapeutic problem.1Early diagnosis and prompt institution of therapy are crucial. The most common complication of bacterial endocarditis is heart failure due to destruction of either the aortic or the mitral valve. Emergency valve replacement is being increasingly attempted in these patients, even before completion of antibiotic therapy, although precise criteria for operative intervention are not well defined.23456There is clearly a need for additional diagnostic methods for rapid determination of the presence and location of valvular vegetations, and for better assessment of valvular destruction and hemodynamic.
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