Clinical, echocardiographic, and operative findings in active infective endocarditis.

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Abstract
Clinical and echocardiographic findings were compared with those found at operation in 18 consecutive patients with active endocarditis undergoing valve replacement for continuing left ventricular failure. A close correlation was shown between vegetations detected by echocardiography and those found at operation. In 10 of 11 patients with clinically suspected severe aortic regurgitation and vegetations only on the aortic valve and in 2 of 3 patients with severe mitral regurgitation echocardiography provided confirmation of the clinical diagnosis. In the 3 patients with clinically suspected aortic and mitral regurgitation, however, cardiac catheterization was necessary to confirm the severity of the valvular regurgitation. In a further 3 patients cardiac catheterization was carried out as the severity of the single valve lesion was difficult to assess or there were associated problems, i.e., chest pain with myocardial infarction and a sinus of Valsalva aneurysm. Four patients had either an abscess, annular infection, a sinus or a ventricular septal defect at the time of operation, which were not detected by echocardiography. Nevertheless, because of their size it would be doubtful if these would have been identified by cardiac catheterization. Echocardiography allowed repeated assessment of the patient so that the optimal time for operation could be determined without the risks of left heart catheterization. Of the 18 patients, 14 (78%) survived to leave the hospital. The follow-up extended to 44 mo. During this time reinfection, prosthetic dehiscence or paravalvular leaks did not occur. In the majority of patients with left sided active infective endocarditis and continuing left ventricular failure resulting from severe valvular disease, the clinical findings together with echocardiography provide a satisfactory preoperative assessment.