CROSS-SECTIONAL ECHOCARDIOGRAPHIC FINDINGS IN VEGETATIVE AORTIC VALVE ENDOCARDITIS

M-mode echocardiograms of two patients with bacterial endocarditis of approximately 4 months' duration showed dense echoes in the area of the aortic valve. In one patient, who had no prior abnormal cardiac findings, the echoes were clearly suggestive of valvular vegetations. The second patient, however, was known to have had aortic valve disease and a systolic murmur for more than a decade; therefore, dense echoes arising from the aortic valve also could have resulted from valvular calcification. In both patients, cross-sectional echocardiography provided important information. In the first patient, retrograde cardiac catheterization was prevented by large and highly mobile masses attached to the aortic cusps that prolapsed into the left ventricular outflow tract during diastole. Aortic valve replacement without further hemodynamic evaluation was recommended. In the second patient, whose blood cultures remained negative after the acute phase of his illness had been treated, cross-sectional echocardiography showed large vegetations on the aortic valve. Intraoperative findings confirmed the echocardiographic interpretation in each case.