Modifications appear in boldface. *These criteria have been universally accepted and are in current use. Reprinted from Li et al24 by permission of the Infectious Diseases Society of America. Copyright 2000, the Infectious Diseases Society of America. Echocardiography Echocardiography is central to the diagnosis and management of patients with IE. As previously stated (Table 3), echocar- diographic evidence of an oscillating intracardiac mass or vegetation, an annular abscess, prosthetic valve partial dehis- cence, and new valvular regurgitation are major criteria in the diagnosis of IE. Both TTE and TEE are done in many patients with IE dur- ing initial evaluation and subsequent follow-up and provide complementary information. Therefore, TTE should be done initially in all cases of suspected IE (Figure). If any circum- stances preclude the securing of optimal echocardiographic windows, including chronic obstructive lung disease, previous thoracic or cardiovascular surgery, morbid obesity, or other conditions, then TEE should be performed as soon as pos- sible after TTE. When TTE is negative and clinical suspicion remains low, then other clinical entities should be considered. If TTE shows vegetations but the likelihood of complications is low, then subsequent TEE is unlikely to alter initial medi- cal management. On the other hand, if clinical suspicion of IE or its complications is high (eg, prosthetic valve or new atrioventricular block), then a negative TTE will not definitely rule out IE or its potential complications, and TEE should be performed first. 