title: Limited reliability of the "negative" two-dimensional echocardiogram in the evaluation of infectious vegetative endocarditis: diagnostic and surgical implications.
abstract: Three patients with vegetative endocarditis involving a native valve, a mechanical prosthesis and a bioprosthetic valve respectively are presented. Each underwent emergency surgical exploration and prosthetic valve replacement based on clinical evidence of vegetative endocarditis after an initial delay following a report of a negative two-dimensional echocardiographic study. These cases emphasize the fact that within the clinical setting in which vegetative endocarditis is strongly suspected a negative two-dimensional echocardiographic study must be interpreted with caution. This is particularly true in patients with fungal, embolic or prosthetic valvular endocarditis. A decision to delay surgical consultation and therapy based upon a negative two-dimensional echocardiographic study in these patients is ill advised and may result in serious thromboembolic complications or even death.
mesh_terms: D000368:Aged; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001705:Bioprosthesis; D002176:Candida albicans / Q000302:isolation & purification; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D004697:Endocarditis, Bacterial / Q000175:diagnosis* / Q000601:surgery; D006349:Heart Valve Diseases / Q000175:diagnosis*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011425:Propionibacterium acnes / Q000302:isolation & purification