[Outcome of echocardiographic vegetations in bacterial endocarditis during and after anti-infective therapy]. / Devenir des végétations échocardiographiques dans l'endocardite bactérienne au cours et après traitement anti-infectieux.

Echocardiography is a practical and reliable method of detecting endocardial vegetations. The aim of this study was to assess the course of echocardiographic vegetations in bacterial endocarditis under anti infectious therapy and to assess the prognostic significance of the vegetations. Twenty four patients with echocardiographic signs of vegetations were included in a standardised protocol: M mode and 2D examination at the beginning and at the end of medical treatment and when possible after bacteriological cure (average period of follow-up 16 +/- 6 weeks). Special attention was paid to the volume (assessed I to III) and acoustic density of the vegetations. Fifteen patients underwent surgery (62.5%). The size of the vegetations did not differ significantly from that observed in the other patients. The size of the vegetations remained constant during medical therapy and after bacteriological cure in 2/3 of cases. The vegetations grew during medical therapy (even when the patients were apyrexic) in 29% of cases, and even after a 40 day course of anti infectious therapy in 2 cases. The size of the vegetations decreases in 3 cases during treatment (2 cases of embolisation) and in 2 cases after bacteriological cure (without embolisation). No correlations could be drawn between the acoustic density of the vegetations and the outcome. In conclusion, the presence of a large vegetation in bacterial endocarditis does not in itself mean a poor prognosis. However, these large vegetations are often associated with severe mutilating lesions (62.5% in our series). The size of the vegetations remained unchanged during and after medical treatment in two thirds of cases.

[Comparison of mono and bidimensional echocardiography in the diagnosis of atrial myxoma]. / Apport comparatif de l'échocardiographie mono et bidimensionnelle dans le diagnostic des myxomes de l'oreillette.

The diagnosis of atrial myxoma, the most common cardiac tumour, has been greatly facilitated by the introduction of echocardiography. The principal echocardiographic features and the diagnostic pitfalls encountered in a personal series of 7 atrial myxomas (5 left and 2 right) studied by M mode and 2-dimensional echocardiography are reported. In M mode, left atrial myxoma is a relatively easy diagnosis when the tumour prolapses into the mitral orifice. On standard mitro-aortic scanning, it is recorded behind the anterior mitral leaflet as a mass of abnormal echos appearing shortly after mitral valve opening. The diagnosis is much more difficult or even impossible in nonprolapsing tumours. Right atrial myxomas, prolapsing into the tricuspid orifice, do not usually pose any diagnotic problems. 2-dimensional echocardiography shows its superiority in the early diagnosis of small, localised, relatively immobile and non-prolapsing tumours. The parasternal (long axis and transverse views), the apical (4 and 2 chamber views) and subxiphoid positions were the most useful incidences and the tumour was visualised as a more or less circumscribed mass of echos. In all cases, 2-dimensional echo provided information on the size, mobility, insertion and the length of the pedicle of the tumour. Atrial myxoma is being recognised more easily and more often nowadays by echocardiography, the diagnostic method of choice, and 2-dimensional studies should be preferred.