Echocardiography and indications for surgery.

Abstract

The decision to undertake surgery in patients with infective endocarditis is mainly based on clinical data. However, echocardiography, in particular using a transoesophageal approach, will offer important guidelines for diagnosis and management. Surgery must be considered in the following cases: ring abscesses or fistulae which make repair more difficult when they are diagnosed at too late a stage; severe valvular regurgitations resulting in a poor haemodynamic tolerance; large and mobile mitral valve vegetation when surgical repair seems feasible. However, it must be stressed that the decision to refer patients for surgery depends on many other parameters including the microorganism involved and physiological status.