Aortic valve endocarditis(AVE) may produce secondary involvement of the mitral aortic-intervalvular fibrosa(MAIVF) and the anterior mitral valve leaflets(AMVL). These complications may result in the systolic regurgitation of blood from the left ventricular outflow tract into the left atrium, or formation of an aneurysm or perforation of the AMVL. Early recognition of these complications is important for optimal management and corrective surgery. The aims of the persent study were to examine the utility of transesophageal echocardiography(TEE) in the diagnosis of these subaortic complications compared to conventional transthoracic echocardiography(TTE) and to observe the prevalence and pattern of these complications.

Both TTE and TEE were performed in patients with AVE from June 1991 to June 1993. A 2.5 MHz probe was used for TTE and a 5 MHz biplane one for TEE with Hewlett Packard SONOS 1,000 All procedures were recorded in super VHS tape and reviewed by two experienced cardiologist. AVE was diagnosed clinically by the presence of continuous bacteremia or demonstration of vegetations during open heart surgery.

Ten consecutive patients with AVE underwent TTE and TEE of these patients, 6(60%) had involvement of subaortic structures, including one with an abscess in the MAIVF, two with perforation of the MAIVF into the left atrium, one with multiple vegetations in the AMVL, and two with pseudoaneurysm formation and perforation of the AMVL, TEE visualized all these lesions with high resolution images, whereas TTE detected only multiple vegetations in the AMVL in one patients and eccentric mitral regurgitation of unknown etiology in 2 patients. In 4 patients, corrective surgery was performed in which the TEE findings were confirmed.

The results implicate that 1) involvement of the subaortic structures would be a common complication in patients with AVE, 2) TEE is superior to conventional TTE in the detection of these complications, and 3) routine screening with TEE would be necessary in patients with AVE to diagnose or exclude these subaortic complications.