Perivalvular Ectension of Infection in Patients with Infectious Endocarditis

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Abstract
Perivalvular extension of infectionis a not-infrequentand potentially fatal complication of bacterial endocarditis. Because the efficacy of various modalities in the diagnosisof such complications is not well established, a selective review of the published literature on this issue is worthwhile. The electrocardiogram is the easiest study to obtain. It is quite specificin identifying perivalvular extensionof infectionwhen conduction systemdisease is demonstrated but has a low degree of sensitivity overall. Transthoracic two-dimensional echocardiography, transesophageal echocardiography, and color-flow Doppler echocardiography are the most practical and useful techniques for diagnosis of perivalvular extension of infection. Magnetic resonance imaging also appears to be an effective tool in this setting; however, because of a paucity of clinical data, its precise utility has not yet been determined. Nuclear medicine studies and computed tomography play a minimal role. Cardiac catheterization is as useful as the echocardiographic techniques but is invasive, not as readilyavailable, and significantly riskier in terms ofcomplications.Anapproach to the diagnosis of perivalvular extension of infection is proposedon the basis ofthe literature review.

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