Prosthetic Aortic Valve Abscess Producing Total Right Coronary Artery Occlusion: Diagnosis by Transesophageal Three‐Dimensional Echocardiography

Horton, Carl J.; Nanda, Navin C.; Nekkanti, Rajasekhar; Mukhtar, Osman; McGiffin, David

doi:10.1046/j.1540-8175.2002.00395.x

Cited by 8 publications

(13 citation statements)

References 4 publications

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“…Only 2 cases involved abscess compression of the right coronary circulation. 9,16 Both patients had prosthetic aortic valves, and we think that ours is the first report of abscess formation involving a native aortic valve and the right coronary artery. Nine cases (43%) involved prosthetic replacement of native aortic valves that were either congenitally bicuspid or tricuspid but with significant stenosis.…”

Section: Discussionmentioning

confidence: 68%

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Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

Jenny¹,

Almanaseer²

2014

Texas Heart Institute Journal

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1 Major clinical features of IE include fever, systemic emboli, congestive heart failure, and renal insufficiency; however, classic peripheral manifestations of endocarditis-splinter hemorrhages, Osler nodes, Roth spots, and Janeway lesions-are observed less often. Rarely is cardiac ischemia or myocardial infarction caused by coronary emboli or obstruction of the coronary ostia by large vegetations. Coronary artery compression by abscess formation, although even less frequent, is important to consider in patients who present with atypical features of an acute coronary syndrome. We discuss the case of an elderly patient in whom these features occurred, and we briefly review the relevant medical literature. Case ReportA 73-year-old woman with a history of aortic stenosis, atrial fibrillation, diabetes mellitus, and a chronic gastrocutaneous fistula and sacral decubitus ulcer presented with sudden-onset back pain and shortness of breath. In the emergency department, she had a temperature of 102.2 °F, a heart rate of 123 beats/min, and a blood pressure of 119/50 mmHg. Physical examination revealed a normal S 1 and S 2 and a harsh grade 2/6 systolic ejection murmur that radiated to the carotid arteries. Also noted were a fistula in the left upper quadrant that drained serous fluid, and a healing sacral ulcer with minimal skin breakdown and no signs of gangrene. Laboratory results included a troponin level of 0.746 µg/L, a creatinine kinase level of 140 U/L, and a creatinine kinase-MB fraction of 11.9 ng/mL. A 12-lead electrocardiogram showed ST-segment elevation in leads V 1 , V 2 , and III, with ischemic-appearing ST-segment depression in leads I and aVL (Fig. 1). Urgent coronary angiograms revealed a mildly dilated ascending aorta and a long, tubular area of the right coronary artery with narrowing that extended almost to the crux ( Fig. 2A). A possible flap suggested right coronary artery dissection, and the presumed diagnosis was coronary dissection. Computed tomographic angiograms of the ascending and descending aorta showed no dissection but revealed an irregular collection of contrast medium along the anterior right side of the aortic annulus (Fig. 2B).The patient's history of chronic infection and elevated white blood cell count on presentation (21 ×10 9 /L) raised concerns of IE, so further imaging of the heart was performed. Two-dimensional transthoracic echocardiograms (TTE) revealed a thickened, calcified, severely stenotic aortic valve with apparent vegetations. A 2-dimensional transesophageal echocardiogram (TEE) revealed vegetations on the aortic valve Case Reports

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Section: Discussionmentioning

confidence: 68%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] We found 21 unique cases, the earliest from 1987. Only 2 cases involved abscess compression of the right coronary circulation.…”

Section: Discussionmentioning

confidence: 99%

Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

Jenny¹,

Almanaseer²

2014

Texas Heart Institute Journal

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“…64,65 Furthermore, 3D echocardiography might be more accurate in identifying bicuspid morphology or in the evaluation of infective endocarditis and its relationship to adjacent structures, such as the coronary arteries. 66,67 However, the suboptimal visualization of the AV remains as the main limitation of 3D echocardiography and requires further technical improvement. Further studies need to determine if 3D echocardiography may offer additional information in this context.…”

Section: Aortic Valve Diseasementioning

confidence: 99%

Real-Time 3-Dimensional Echocardiography in the Operating Room

Jungwirth

Mackensen

2008

Semin Cardiothorac Vasc Anesth

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Real-time 3-dimensional transesophageal echocardiography (RT-3D-TEE) represents a novel clinical and intuitively educational perioperative cardiovascular imaging modality. The development of RT-3D-TEE allows for live 3D imaging as it circumvents most of the disadvantages of reconstructive 3D methods. RT-3D-TEE will likely revolutionize perioperative assessment of complex 3D structures, such as the mitral valve (MV), as it provides important mechanistic insights into functional and ischemic mitral regurgitation. The MV is particularly suited to live RT-3D-TEE assessment because of the complex interrelationships among the valve, chordae, papillary muscles, and myocardial walls. The 3D en face view of the MV is in accordance with the surgical view and allows to illustrate the unique saddle shape of the MV annulus and to define and localize mitral leaflet lesions in MV prolapse, endocarditis, or congenital MV abnormalities, all potentially important in guiding surgical repair. RT-3D-TEE will soon be integrated into routine perioperative practice. Its unique ability of real-time acquisition, online rendering and cropping capabilities, accurate identification of the precise pathology and location of cardiac disease, together with its ability to promptly quantify 3D data sets using built-in software, will likely help in transitioning this modality into standard of care.

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“…These abscesses may compress a coronary artery, but there is a paucity of cases reported in the literature in which the diagnosis was made using echocardiography. Also, the echocardiographic findings are not convincing in some of the published cases . We present a patient in whom a perivalvular abscess involving a prosthetic AV causing compression of the proximal left coronary system was diagnosed by two‐dimensional transesophageal echocardiography (2DTEE) and live/real time three‐dimensional transesophageal echocardiography (3DTEE).…”

mentioning

confidence: 93%

“…In the second patient, also with a native AV abscess, no figure was provided to show LMCA compression by the abscess and there is no mention of pulsed Doppler findings. Horton et al . from our Echo Laboratory demonstrated complete occlusion of the proximal right coronary artery by an aortic abscess by 3DTEE reconstruction and reversal of diastolic flow from the coronary artery into the aorta.…”

mentioning

confidence: 98%

Usefulness of two‐ and three‐dimensional transesophageal echocardiography in the assessment of proximal left coronary system compression by a paraprosthetic aortic valve abscess

et al. 2017

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Paraprosthetic aortic valve abscess represents a rare, but lethal complication of infective endocarditis. We report a case of proximal left coronary system compression by a paraprosthetic aortic valve abscess whose detection was augmented using live/real time three-dimensional transesophageal echocardiography. Our case illustrates the usefulness of combined two- and three-dimensional transesophageal echocardiography in detecting this finding.

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Prosthetic Aortic Valve Abscess Producing Total Right Coronary Artery Occlusion: Diagnosis by Transesophageal Three‐Dimensional Echocardiography

Abstract: We present a patient with total right coronary artery occlusion produced by a prosthetic aortic valve abscess. The diagnosis was made by transesophageal three-dimensional echocardiography.

Cited by 8 publications

References 4 publications

Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

Aortic Valve Endocarditis Complicated by ST-Elevation Myocardial Infarction

Real-Time 3-Dimensional Echocardiography in the Operating Room

Usefulness of two‐ and three‐dimensional transesophageal echocardiography in the assessment of proximal left coronary system compression by a paraprosthetic aortic valve abscess

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