Echocardiography is crucial in the diagnosis of infectious endocarditis (IE). We assessed the correlation between transesophageal echocardiography (TEE) and surgical findings. A retrospective study of IE patients who underwent surgery. Discrepancies between TEE and surgical findings were defined as ≥ 1 infected valves, vegetations and abscess, and vegetations size ≥5 mm. Descriptive statistics and regression analysis were performed. Eighty patients were included. Mean age was 55.03 years, 26.3% had prosthetic valves. S. aureus and S. viridans spp were identified in 22.5% and 20% of cases, respectfully. On TEE, 84% had vegetations, and 31.2% had abscesses. Mitral and aortic valves were affected in 51%, and 40%, respectfully. TEE and surgical findings highly correlated regarding abscess count, valve involvement, and vegetation size. Significantly, more vegetations were observed during surgery compared to TEE (19% vs. 11%). In 46 patients (57.5%) (Group 1) no discrepancies were found. In 34 patients (42.5%) ≥ 1 discrepancy was found (Group 2). Patients in Group 1 vs. 2 presented with significantly more weakness (80.4% vs. 52.9%) and confusion (21.2% vs. 2.9%). Mitral valve involvement [21 (45.7%) and 24 (70.6%)], and larger vegetations on TEE (15.17 mm vs. 20 mm) were significantly more common in Group 2. S. viridans was linked to more discrepancies (p = 0.07). In a multivariate model Charlson index and vegetation size were associated with discordant findings. Discrepancies were observed between TEE and surgical findings, especially in patients with S. viridans IE or mitral valve involvement. These differences did not affect surgery appropriateness.
Keywords: Staphylococcus aureus; Streptococcus viridans; Cardiac surgery; Echocardiography; Infective endocarditis; Vegetation.
© 2026. The Author(s), under exclusive licence to Springer Nature B.V.