TEE may miss initial paravalvular abscesses, particularly when the study is performed early in the patient s ill- ness. In such cases, the incipient abscess may be seen only as nonspecific paravalvular thicken- ing, which on repeat imaging across several days may become recognizable as it expands and cav- itates. Similarly, paravalvular fistulae and pseu- doaneurysms develop over time, and negative early TEE images do not exclude the potential for their development. A single negative TEE study cannot rule out underlying IE, and a repeat TEE study should be performed when a suspicion of persistence of infection remains or if complica- tions ensue. Conversely, in the absence of clini- cal deterioration or new signs and symptoms, routine follow-up echocardiography is probably of only limited clinical utility.24,41,42,44 46 8. Intraoperative TEE during cardiac surgery has an important role in the evaluation and quality con- trol of a large variety of pathologies. Clinical and echocardiographic characteristics may change during an episode of IE because of the pro- longed active phase and fluctuating course of this disease. Even if preoperative TEE has been performed, vegetation change/embolization or extension of the infectious process beyond the valve tissue may occur. In addition, other valves may become involved as the disease timeline progresses. Intraoperative TEE has been invalu- able for baseline reassessment of anatomic or hemodynamic changes that may occur in the interval between the diagnostic echocardiogram and the time of surgery. TEE is also an important monitoring tool for evaluation of operative com- plications, such as air emboli, and an important adjunct to ensure the quality of the intended 9. The recently published randomized POET (Partial Oral Treatment of Endocarditis) trial studied 400 patients with stable left-sided IE caused by streptococcus, Enterococcus faecalis, S. aureus, or coagulase-negative staphylococci. 