Which echocardiographically unrecognised complications of native aortic valve endocarditis may be found during operation

: The aim of the study was to determine the type and localisation of complications of aortic valve endocarditis, that have not been recognised on transthoracic (TTE) and/or transesophageal (TEE) echocardiographic study. The echocardiographic findings were retrospectively compared and contrasted with direct surgical inspection in 156 consecutive adults operated on native aortic valve endocarditis in our institute during the last 8 years. We analysed recognition of abscess, pseudoaneurysm, fistula and cusp rupture. Periannular complications were detected at operation in 51 pts, cusp rupture in 97 pts. Sensitivity of TTE in recognition of abscesses was 55%, TEE--60%; pseudoaneurysm--TTE--64%, TEE--100%; fistula--TTE 60%, TEE 100%; cusp rupture--TTE 65%, TEE 81%. Both echocardiographic methods have some inherent limitations while diagnosing complications of aortic valve endocarditis. In particular, these include small abscesses and cusp rupture. Using both modalities in a complementary way seems to offer the best approach in overall definition of the extent of inflammation.