Improvement in the diagnosis of abscesses associated with endocarditis by transesophageal echocardiography

Article Abstract:

Echocardiography, which utilizes reflected ultrasonic sound waves to generate an image of the heart, is a noninvasive imaging method well suited to the observation and diagnosis of a number of heart problems, such as the growth of vegetations in patients with infective endocarditis (inflammation of the membrane lining the valves and chambers of the heart). These vegetations reflect the luxurious growth of microorganisms that have gained a foothold on a heart valve or neighboring area. The development of abscesses (collections of pus) in association with these vegetations usually indicates that the disease will take a more severe course; surgical and autopsy specimens suggest that abscesses occur in about 30 percent of the cases of infective endocarditis. A study was undertaken to determine if transesophageal echocardiography might be as effective in the detection and observation of abscesses as it is in the observation of vegetations. (In transesophageal echocardiography, the ultrasonic device is placed in the esophagus, and thus the signal does not have to traverse bone, as is the case with transthoracic echocardiography.) Two-dimensional transesophageal echocardiography was used to examine 118 patients who developed infective endocarditis after heart valve replacement. A total of 46 abscesses in 44 patients could be confirmed either by surgery or autopsy. Abscesses were most commonly associated with endocarditis of the aortic valve, and over half of the abscesses involved infection with staphylococcal species. Of the endocarditis cases that did not involve abscesses, 16 percent were the result of staphylococcal infection. Among the patients with abscesses, mortality was 22.7 percent, compared with 13.5 percent for patients without abscesses. Transesophageal echocardiography detected 87 percent of the abscesses, far superior to the 28 percent detection rate achieved with transthoracic echocardiography. The reliability of both methods was very high. The findings demonstrate that transesophageal echocardiography is superior in detecting abscesses in the hearts of patients with infective endocarditis. Better imaging should lead to earlier treatment and perhaps a better outcome for these patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Echocardiography, Endocarditis, Bacterial, Bacterial endocarditis, Abscess, Endocarditis

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Transesophageal echocardiography

Article Abstract:

Transesophageal echocardiography (TEE) has revolutionized the diagnosis of many cardiovascular diseases but it is still an invasive procedure and should be used judiciously. TEE involves inserting an ultrasound probe down the esophagus in order to visualize the heart and surrounding structures. It is more accurate than a chest ultrasound in detecting bacterial infection of heart valves, a condition called infective endocarditis. It can also detect blood clots in the heart that could travel to the brain, causing a stroke. It can detect defects in the heart's septum and the development of probes small enough for children may assist in detecting other types of congenital heart disease. It can be used in the emergency room to detect aortic dissection and other critical injuries and can be used in patients who are on ventilators. Because it is small and portable, it can be used at the bedside. Future innovations include smaller size and the ability to produce three-dimensional images.

Cardiovascular diseases

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Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta

Article Abstract:

Transesophageal echocardiography could be the diagnostic method of choice for detecting rupture of the aorta in the emergency room. In this procedure, an ultrasound probe is inserted in the mouth and passed down the esophagus. Researchers used the procedure on 93 patients admitted to the emergency room with blunt chest trauma. Although many of the patients were critically injured, the procedure was successfully completed within 30 minutes. Findings were confirmed by aortic angiography, surgery, or at autopsy. Eleven patients were diagnosed with aortic rupture using transesophageal echocardiography. One scan was a false positive as indicated by an angiogram that revealed an intact aorta. However, it is possible that the echocardiography detected a tear in the aorta that was too small to be detected by an angiogram. All 10 true cases of aortic rupture were confirmed by angiographic or surgical findings. Six of these patients had no external signs of chest injury.

Injuries, Chest, Thoracic injuries, Aorta, Thoracic, Thoracic aorta

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