P691Echocardiographic findings in the first transoesophageal examination performed on patients with native valve infective endocarditis. Are there any differences according to the causative microorganism?


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Abstract

Purpose: to describe the main echocardiographic findings present in the first transoesophageal echocardiogram (TOE) performed in patients with left-sided native valve infective endocarditis (IE). To analyse the differences in the echocardiographic abnormalities found according to the causative microorganism.Methods: we have analysed the TOE findings of 288 episodes of left-sided native valve IE diagnosed in two tertiary centres between 1996 and 2010. We have performed a comparative analysis of the findings between the more common microorganisms involved (Viridans group Streptococci, Staphylococcus aureus and Enterococci).Results: The most frequent causative microorganisms were Staphylococcus aureus (20%), followed by viridans group Streptococci (17%) and Enterococci (13%). The aortic valve was affected in 52% of the cases and the mitral valve in 48%. In 14% of the episodes, the infection was multivalvular. A vegetation was identified in 91% of the TOEs. The mean area of the vegetation was 1.4 cm2± 1.3. Up to 15% of the patients presented a periannular complication in the TOE (6% abscess, 10% pseudoaneurysm and 1% fistula). A perforation of the leaflets was found in 20% of the cases and rupture of the valve in 9%. The infection caused significant stenosis of the valve in 15% of the patients and significant regurgitation in 77%. When analysing the findings according to the causative microorganism we have found no significant differences but the incidence of less significant valvular stenosis and less significant valvular regurgitation in the Staphylococcus aureus group (7% VS 25% in viridans Streptococci VS 29% in Enterococci, p=0,02 and 65% VS 89% VS 88%, p=0,005; respectively), this finding can be explained because the time between the onset of the symptoms and the TOE is shorter in the patients with Staphylococcus aureus infection (in 78% of the cases is shorter than 15 days VS 21% VS 20%, p=0,001)Conclusions: in the first TOE performed in patients with left-sided native valve IE there is a high rate of valvular dysfunction, predominantly regurgitation. Perivalvular extension of the infection is not common. There are no differences in the first echocardiographic appearance of the disease according to the causative microorganism, but a lower rate of valvular dysfunction in the cases of Staphylococcus aureus IE.

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