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October 1983

Clinical Implications of Large Vegetations in Infectious Endocarditis

Author Affiliations

From the Section of Cardiology, the Department of Medicine, University of Southern California School of Medicine (Drs Chandraratna and Nimalasuriya), Los Angeles; the Medical Service, Long Beach (Calif) Veterans Administration Medical Center (Drs Wong, Wishnow, and Dusitnanond); and the University of California, Irvine, Medical Center, Orange.

Arch Intern Med. 1983;143(10):1874-1877. doi:10.1001/archinte.1983.00350100036011

• Thirty-four patients with clinical infectious endocarditis were examined by M-mode and two-dimensional (2D) echocardiography. Vegetations were identified in 16 patients (47%) by M-mode and in 27 patients (87%) by 2D echocardiography. Vegetations identified by 2D echocardiography were categorized as small (<5 mm), medium (5 to 9 mm), or large (≥10 mm). Large vegetations were caused by a variety of organisms, had a higher incidence of surgery (44% v 0%), and had no increased incidence of stroke or death. The larger the vegetation, the more detectable it was by M-mode. Aortic valve vegetations were associated with a higher incidence of congestive heart failure (CHF) (67% v 14%) and stroke (44% v 9%). Four patients with large aortic valve vegetations had the highest complication rate; CHF developed in all four, two had valve replacement, one had a stroke, and two died.

(Arch Intern Med 1983;143:1874-1877)

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