Mitral valve replacement in infective endocarditis as prophylaxis against embolism. Identification of patients at risk by 2-dimensional echocardiography.

A 36-yr-old woman and a 46-yr-old man had infective endocarditis of the mitral valve. Examination by 2-dimensional dynamic echocardiography demonstrated large mobile vegetations in both patients, and the display pointed to an ominous risk of embolism. Heart surgery with valve replacement was performed, the main indication being prophylaxis against embolism; the operative findings seemed to justify the assumption of imminent risk of embolism. It is suggested that the display of dynamic morphology of valvular vegetations by 2-dimensional echocardiography can be useful in identifying a subset of patients at high risk of embolism during infective endocarditis. However, more experience is needed before definite conclusions can be drawn regarding the role of early operation as prophylaxis against impending embolism.