[Management of imminent emboli in endocarditis: are they predictable?].

BACKGROUND: Patients with infective endocarditis are at risk for embolic complications. Emboli often occur very early in the course of endocarditis. VEGETATIONS: Pathologic substrate of emboli are vegetations which can be visualized by echocardiography with high sensitivity and accuracy. The question whether echocardiographically derived characteristics of vegetations such as size, mobility, location, and "consistency" poses an increased risk for complications, in particular arterial embolism, remains controversial. An analysis of pooled studies revealed an odds ratio of 2-3 for increased risk of embolization in the presence of a vegetation > 10 mm, particularly in mitral valve endocarditis. TREATMENT AND PREVENTION: However, because of poorly defined co-variables, lack of standardized methods for measurements, as well as a high overlap in the vegetation size between patients with and without embolic complications, no therapeutic implications can be drawn on the echocardiographic findings alone. It appears that an early diagnosis with initiation of an adequate antibiotic therapy is still the best prevention for embolic complications.