Fluoroscopic diagnosis of native valve endocarditis.

A 59-year-old man who had a history of kidney transplantation and progressive renal insufficiency during the previous several months presented with pulmonary edema and staphylococcal sepsis. His past medical history included hypertension, diabetes, and mild aortic stenosis, which had been detected by echocardiography 1 month earlier during the evaluation of a heart murmur. Transesophageal echocardiography demonstrated a vegetation on the aortic valve with severe valvular regurgitation. The patient was transferred to our medical center for cardiac catheterization before surgical intervention. Using an all-digital, flat-panel image acquisition system (Innova, GE Medical Systems), we were able to see the vegetation using fluoroscopy alone (see Data Supplement video). The high-resolution images allowed us to visualize the vegetation while maneuvering the coronary catheters, potentially minimizing the risk of embolization. The patient subsequently underwent aortic valve replacement. To our knowledge, this is the first report of native valve vegetation visualization using fluoroscopy alone, and it was likely facilitated by the improved dynamic range and signalto-noise ratio afforded by the all-digital system.