Key Points

1. TEE is not necessary in patients with low likelihood of IE and good TTE images.

2. Despite good TTE images, TEE is recommended in the setting of suspected prosthetic valve IE, suspected culture negative IE, and bacteremia with virulent organisms such as Staphylococcus aureus.

3. TEE is indicated in the assessment of perivalvular abscess and related complications in both native valve IE and prosthetic valve IE.

4. Perivalvular abscess is a dynamic process, and TEE can provide useful prognostic information during the follow-up including in patients who have undergone cardiac surgery for perivalvular abscess.

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