Echocardiography frequently provides unique and essential information which, in addition to blood culture, constitutes a major criterion for establishing a diagnosis of endocarditis. Valvular vegetations are pathognomonic signs of endocarditis and can be identified with either transthoracic or, more reliably, transesophageal echocardiography. Vegetation size, as determined by echocardiography, has been shown to be a predictor of embolic events and death. Complications of endocarditis such as abscess formation, valvular perforations, or the rupture of a sinus Valsalvas are best diagnosed by echocardiography. Moreover, echocardiography can be repeated to monitor the response to antibiotic therapy or determine the need for surgical intervention. A normal echocardiogram does not entirely exclude the presence of endocarditis.

Transesophageal echocardiography (longitudinal view) of aortic valve endocarditis with abscess formation affecting the valvular ring and the anterior mitral leaflet. (Reproduced with permission from G. Maurer, Transesophageal echocardiography, McGraw-Hill, New York, 1994.)

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