The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography

Abstract

Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.

More Than a Simple Vegetation: The Trifecta of Mitral Valve Leaflet Perforation, Windsock Aneurysm, and Mitral Valve Abscess

“…Three-dimensional TEE may be incremental in these cases particularly through improved spatial resolution and delineation of anatomic relationships. 13 However, this may not always be possible with significant acoustic shadowing similarly affecting 2D and 3D visualization, in which case off-axis and transgastric imaging is important to further interrogate the posterior aspects of the valve. Threedimensional multiplanar reconstruction is additive and allows detailed anatomic assessment in multiple planes and identification of involved structures.…”

“…Three-dimensional TEE is particularly beneficial in the preoperative setting, in which anticipating complications such as abscess or fistula formation, leaflet perforations, and commissural MR can facilitate operative planning and repair strategies. 13 Although there are several reports in the literature of native MVendocarditis complicated by annular abscess [16][17][18] and less commonly MV aneurysms, 8,9 concurrent pathology represents a rarity. We were unable to find any previous reports of these uniquely uncommon endocarditis complications occurring in the same patient.…”

3D echocardiography allows rapid and accurate surgical planning in complex aortic root abscess cases

“…Whereas 2DE amounts to a single tomographic slice through a region of interest, 3D-TOE can provide visual information of that entire region through acquisition of a volume of data. This is especially important when large valvular vegetations or abscesses are present, as 2D-TOE can fail to provide sufficient information regarding the relationship between vegetations, prosthesis, and adjacent structures (4). 3D-TOE permits high levels of post-processing, with a single 3D-TOE volumetric image allowing (a) reconstruction of volume-rendered 3D images, (b) generation of MPR 2D images from unlimited planes and (c) real-time live 3D imaging.…”

Role of 3D Echocardiography in Cardiac Surgery: Strengths and Limitations

“…Three-dimensional TEE FV and real-time modes reveal pathology that is not readily seen with 2D echocardiography [ 65 ]. There is a good correlation between 3D TEE assessment of pathology and corresponding operative findings [ 66 ]. Morphology and size of valvular vegetations can be assessed, superior to 2D TEE [ 67 ].…”