Intraoperative Transesophageal Echocardiography in the Cardiac Surgical Patient with Infective Endocarditis

Echocardiographic assessment of infectious endocarditis provides dynamic and detailed imaging, which may prove advantageous over static modalities such as computer topography. Intraoperative assessment of infectious endocarditis remains “mandatory” according to various societal guidelines. Echocardiographic evaluation within the intraoperative period not only allows for diagnosis and assessment of common pathologies, such as valvular perforation, vegetations, abscesses, pseudoaneurysms, fistulas, non-native valvular dehiscence, and cardiac implantable electronic device endocarditis, but also allows for diagnosis of secondary pathologies. The acute nature of infectious endocarditis does not allow for compensatory mechanisms to develop for the infectious pathologies, and therefore hemodynamic instability is common. During the intraoperative period, echocardiographic assessment and goal-directed treatment remains a critical component of quality patient management.