Discussion

Summary

Active infective endocarditis is a non-uniform disease characterized by a range of clinical outcomes. Without precise echocardiographic assessment mortality is unpredictable on the basis of clinical appearance alone. Echocardiography is still the optimal, most cost-effective diagnostic bedside tool, allowing the diagnosis to be determined and helping to follow up patients until the final treatment is completed. The proposed new criteria of echocardiographic assessment of active infective endocarditic lesions seem to represent a promising step in applying a more precise treatment concept. Great emphasis has to be placed on the complications that can develop. The optimistic conclusion of this piece of work is that this disease, if treated in time, can have an acceptably low mortality. On the other hand, destructive endocarditis complicated by shock is associated with a substantial mortality rate and should be treated surgically without delay.