M- mode echocardiographic features of severe aortic valve endocarditis

We describe and discuss the M-mode echocardiographic featuresin 10 patients with infective endocarditis of the aortic valverequiring surgery. Operative findings and aortic valve histologywere obtained in each case. Vegetations were visualized in sixout of seven patients (86%) with proven vegetations while pre-existingaortic valve disease masked their echocardiographic recognitionin one patient. Diastolic echoes indistinguishable from vegetationswere recorded from the ragged edge of a perforated aortic cuspin one patient who at operation had no demonstrable vegetations.Left, ventricular outflow tract (LVOT) echoes were seen in fivepatients. Non-vibrating LVOT echoes were identified as vegetationswhile rapidly vibrating LVOT echoes were recorded from a flailaortic cusp. Premature mitral valve closure (PMVC) was seenin five out of seven patients (70%) with a short (< fourmonth) history of severe aortic re gurgitation. Subannular aneurysmswere detected in three out of five patients (60%) with thiscomplication. Increased septal and left ventricular posteriorwall motion suggestive of severe aortic regurgitation was seenin each case. The detection of a flail aortic valve leaflet, PMVC and subannularaneurysms indicates the need for surgery. The demonstrationof vegetations defines a further subgroup of patients who shouldbe managed in a centre with facilities for cardiac surgery.Echocardiography obviated the need for pre-operative cardiaccatheterization in nine out of 10 patients (90%).