treating team for clinical indications. All TTEs were performed by
using Hewlett Packard Sonos 5500 machines (Hewlett Packard,
Andover, MA) with 2- to 12-MHz phased-array transducers. Twodimensional
imaging from multiple tomographic planes and spectral
Doppler and color-flow imaging were used in all patients.
Images were recorded on 1⁄2-in super-VHS videotape and in digital
full-screen cine loop display format (EnConcert, Andover, MA).
Findings consistent with IE included vegetation, abscess, new
valvular regurgitation, and otherwise unexplained valvar dysfunction
as defined previously.6 A vegetation (Fig 1) was defined
as an irregularly shaped echogenic mass adherent to a valve or
endothelial surface. Characteristics used to identify a vegetation
included oscillating motion (high-frequency movement independent
from associated valvar motion), mobility (exceeding and
independent of the associated valve structure) and shaggy or
irregular surfaces. An abscess was defined as a thickened area or
mass within the myocardium or annular region, characterized by
an irregular, nonhomogeneous echogenic appearance. Other unexplained
valvular abnormalities consistent with IE included new
valvular regurgitation at least moderate in severity or destruction
or perforation of valve tissue