M-mode echocardiographic features of severe aortic valve endocarditis.

We describe and discuss the M-mode echocardiographic features in 10 patients with infective endocarditis of the aortic valve requiring surgery. Operative findings and aortic valve histology were obtained in each case. Vegetations were visualized in six out of seven patients (86%) with proven vegetations while pre-existing aortic valve disease masked their echocardiographic recognition in one patient. Diastolic echoes indistinguishable from vegetations were recorded from the ragged edge of a perforated aortic cusp in one patient who at operation had no demonstrable vegetations. Left ventricular outflow tract (LVOT) echoes were seen in five patients. Non-vibrating LVOT echoes were identified as vegetations while rapidly vibrating LVOT echoes were recorded from a flail aortic cusp. Premature mitral valve closure (PMVC) was seen in five out of seven patients (70%) with a short (less than or equal to four month) history of severe aortic regurgitation. Subannular aneurysms were detected in three out of five patients (60%) with this complication. Increased septal and left ventricular posterior wall motion suggestive of severe aortic regurgitation was seen in each case. The detection of a flail aortic valve leaflet, PMVC and subannular aneurysms indicates the need for surgery. The demonstration of vegetations defines a further subgroup of patients who should be managed in a centre with facilities for cardiac surgery. Echocardiography obviated the need for pre-operative cardiac catheterization in nine out of 10 patients (90%).