Liu F, Ge J, Kupferwasser I, Meyer J, Mohr-Kahaly S, Rohmann S, Erbel R
Department of Cardiology, University Essen, Germany.
Echocardiography. 1995 Nov;12(6):637-50. doi: 10.1111/j.1540-8175.1995.tb00857.x.
Infective endocarditis is still a great clinical challenge. Its diagnosis is difficult to establish, and mortality has remained around 30%. Early diagnosis and optimal treatment are crucial fo prognosis improvement. Echocardiography plays an indispensable role in the management of this disease, especially with the recently introduced approach, transesophageal echocardiography (TEE). TEE can overcome the limitations of transthoracic echocardiography (TTE) and is superior to TTE in almost every way in providing earlier and more information for the diagnosis and treatment of infective endocarditis. TEE detects valve vegetations with much higher sensitivity and specificity than TTE. It can demonstrate smaller vegetations in the early stage of the disease and vegetations on atypical locations (e.g., mitral valve annulus), and provides detailed characterization of vegetations (e.g., location, size, mobility, and changes during treatment). Such information is of great prognostic value and may help in selecting proper treatment. TEE is more sensitive for detecting complications, such as mitral valve perforation, abscess, and subaortic complications, which respond poorly to medicine and for which timely surgery may be the best treatment. For those with prosthetic valve endocarditis, TEE is especially useful because TTE is greatly limited by the acoustic shadow of prostheses. Both positive and negative results of TEE examination are valuable for confirming or excluding infective endocarditis. TEE also plays a unique role in intraoperative monitoring and can assess surgical results before the chest is closed. TEE has become an invaluable tool for the diagnosis and management of patients with suspected or known infective endocarditis.
感染性心内膜炎仍然是一个巨大的临床挑战。其诊断难以确立，死亡率一直保持在30%左右。早期诊断和优化治疗对于改善预后至关重要。超声心动图在该疾病的管理中发挥着不可或缺的作用，尤其是最近引入的经食管超声心动图（TEE）方法。TEE可以克服经胸超声心动图（TTE）的局限性，在为感染性心内膜炎的诊断和治疗提供更早且更多信息方面几乎在各个方面都优于TTE。TEE检测瓣膜赘生物的敏感性和特异性比TTE高得多。它可以在疾病早期显示较小的赘生物以及非典型部位（如二尖瓣环）的赘生物，并提供赘生物的详细特征（如位置、大小、活动度以及治疗期间的变化）。这些信息具有重要的预后价值，可能有助于选择合适的治疗方法。TEE在检测并发症方面更敏感，如二尖瓣穿孔、脓肿和主动脉瓣下并发症，这些并发症对药物治疗反应不佳，及时手术可能是最佳治疗方法。对于人工瓣膜心内膜炎患者，TEE特别有用，因为TTE受人工瓣膜声影的限制很大。TEE检查的阳性和阴性结果对于确诊或排除感染性心内膜炎都很有价值。TEE在术中监测中也发挥着独特作用，并且可以在关闭胸腔前评估手术结果。TEE已成为诊断和管理疑似或已知感染性心内膜炎患者的宝贵工具。
