Transesophageal and Doppler echocardiography in the diagnosis and management of infective endocarditis.

T he evaluation of infective endocarditis (IE), a complex and diagnostically difficult disease, has benefited dramatically from the developments in noninvasive cardiology, particularly in echocardiography. In the preantibiotic era, the disease progressed inexorably until death, with the diagnosis often confirmed at autopsy. With the development ofmodern antibiotic therapy and cardiothoracic surgery, the potential for lifesaving therapeutic interventions has increased the value of malcing an early diagnosis for improved outcome. Patients with IE now present earlier in their illness when classic Oslerian clinical stigmata may be absent (eg, Roth spots). The rampant abuse of intravenous drugs has increased the prevalence of both bona fide and suspected cases ofIE. Two-dimensional transthoracic echocardiography (TTE) has improved diagnostic acumen in IE by demonstrating both valvular and myocardial pathology; moreover, through the use of Doppler echocardiography, noninvasive hemodynamic assessment ofcardiac function is readily available. In addition to diagnosing vegetative IE and identifying valvular abnormalities predisposing to IE, the TTE has also become very useful for defining the need for surgery and guiding the eventual cardiac repairs. Transesophageal echocardiography (TEE) is the latest technologic advance in the noninvasive evaluation of the patient with IE, with a potential to further add to our diagnostic and prognostic armamentarium.