Heart valve disease module 8: endocarditis

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If the first TTE is normal but the suspicion of IE persists it is usually worth waiting 7–10 days and then booking a TOE.20 If the patient is frail then a repeat TTE may help since new regurgitation can be taken as a sign of IE even in the absence of vegetations. The findings on echocardiography are:

  • vegetation (see figure 3)

    • Figure 3. Vegetation on a pulmonary valve. This is a parasternal short-axis transthoracic echocardiogram in a patient with gonococcus
  • abscess (see figure 4)

    • Figure 4. Parasternal short-axis view showing an abscess between the pulmonary artery and aorta
  • fistula (see figure 5)

    • Figure 5. Fistula
  • paraprosthetic regurgitation of a replacement heart valve and,
  • valve destruction (see figure 6).



    • Figure 6. Valve destruction. This shows parasternal long-axis views in a patient with fever and blood cultures positive for Staphylococcus aureus. In the top two panels, the aortic valve is normal while in the bottom panel, only three days later, there is mild but definite new aortic regurgitation

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