谷本 京美

Kyomi TANIMOTO

東京女子医科大学循環器内科教室

Department of Cardiology, Tokyo Women's College Heart Institute of Japan

キーワード : Infective endocarditis (IE) , Transesophageal echocardiography (TEE)

Here I attempt to clarify the usefulness of echocardiography in the diagnosis of infective endocarditis. The study population consisted of 43 patients who had undergone surgical treatment during the active phase of endocarditis from January 1989 to September 1996. All patients were examined before surgery with both transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). The findings of both modalities were compared with the operative findings, which included vegetation, ring abscess, mycotic aneurysm, perforation, valve aneurysm, and torn chordae. In aortic valve endocarditis, ring abscess was more frequently detected by TEE than by TTE (100% vs 20%). Detection rates for vegetation, mycotic aneurysm, perforation, and valve aneurysm were the same with TTE and TEE, however. In mitral valve endocarditis , valve aneurysm was more frequently detected by TEE than by TTE (100% vs 20%), although the rates at which vegetation, perforation, and torn chordae were detected were the same. TTE showed vegetation in only 25% of patients with prosthetic valve endocarditis and ring abscesses in 50%; TEE showed both vegetation and ring abscess in 100% of these cases. Vegetations in 16 patients with thromboembolism were larger (more than 10 mm), more mobile, and more often multiple, and had lower echodensity than those in 15 patients without thromboembolism. Four of 13 patients with aortic valve endocarditis complicated by subaortic infection had congestive heart failure (CHF) and thromboembolism: Five of these patients underwent aortic and mitral valve replacement ((DVR, i.e. , aortic valve replacement (AVR) plus mitral valve replacement (MVR)); 1, Bentall's operation; 2, translocation method; and only 5, AVR. Four patients died. Another 12 patients with aortic valve endocarditis with no subaortic infection had no CHF, and their prognosis was good. The operative procedure was AVR in 11 patients and DVR in 1 patient. I thus found that (1) TEE revealed ring abscesses more frequently than TTE in aortic valve endocarditis; (2) TEE revealed valve aneurysms more frequently than TTE in mitral valve endocarditis; (3) TEE revealed 100% of the vegetations and ring abscesses in prosthetic valve endocarditis; (4) vegetations in patients at higher risk for thromboembolism were mobile, multiple, low echodensity, and diameter more than 10 mm; and (5) patients with subaortic infection had a poorer prognosis than patients without subaortic infection and required more complicated operative procedures in aortic valve endocarditis.