Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review

Carević, Vedran; Mladenović, Zorica; Perković-Avelini, Ružica; Bečić, Tina; Radić, Mislav; Fabijanić, Damir

doi:10.3390/medicina58010023

Cited by 8 publications

(10 citation statements)

References 21 publications

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“…The favorable results reported in this present study outline how our current practice, based on long-standing experience with different and evolving modalities of minimal access settings for MV surgery, allows us to reach a satisfactory outcome while guiding the patient toward the safest approach. A careful selection of the patient before skin incision is required; transesophageal echocardiography is a mandatory tool to estimate the risk of embolization in relation to the size and, even more importantly, the mobility of the vegetations characterizing the IE process, to exclude aortic valve involvement, to define the likelihood of a conservative MV procedure, to exclude the involvement of perivalvular structures and abscesses, and to assess prosthetic valve impairment [ 37 ]. Angiography, vascular computerized tomography scan, or both are mandatory for the diagnosis of peripheral vascular disease.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis

Barbero,

Pocar,

Brenna

et al. 2023

Medicina

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Background. Minimally invasive surgery via right mini-thoracotomy has become the standard of care for the treatment of mitral valve disease worldwide, particularly at high-volume centers. In recent years, the spectrum of indications has progressively shifted and extended to fragile and higher-risk patients, also addressing more complex mitral valve disease and ultimately including patients with native or prosthetic infective endocarditis. The rationale for the adoption of the minimally invasive approach is to minimize surgical trauma, promote an earlier postoperative recovery, and reduce the incidence of surgical wound infection and other nosocomial infections. The aim of this retrospective observational study is to evaluate the effectiveness and the early and late outcome in patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Methods. Prospectively collected data regarding minimally invasive surgery in patients with mitral valve infective endocarditis were entered into a dedicated database for the period between January 2007 and December 2022 and retrospectively analyzed. All comers during the study period underwent a preoperative evaluation based on their clinical history and anatomy for the allocation to the most appropriate surgical strategy. The selection of the mini-thoracotomy approach was primarily driven by a thorough transthoracic and especially transesophageal echocardiographic evaluation, coupled with total body and vascular imaging. Results. During the study period, 92 patients underwent right mini-thoracotomy to treat native (80/92, 87%) or prosthetic (12/92, 13%) mitral valve endocarditis at our institution, representing 5% of the patients undergoing minimally invasive mitral surgery. Twenty-six (28%) patients had undergone previous cardiac operations, whereas 18 (20%) presented preoperatively with complications related to endocarditis, most commonly systemic embolization. Sixty-nine and twenty-three patients, respectively, underwent early surgery (75%) or were operated on after the completion of the targeted antibiotic treatment (25%). A conservative procedure was feasible in 16/80 (20%) patients with native valve endocarditis. Conversion to standard sternotomy was necessary in a single case (1.1%). No cases of intraoperative iatrogenic aortic dissection were reported. Four patients died perioperatively, accounting for a thirty-day mortality of 4.4%. The causes of death were refractory heart or multiorgan failure and/or septic shock. A new onset stroke was observed postoperatively in one case (1.1%). Overall actuarial survival rate at 1 and 5 years after operation was 90.8% and 80.4%, whereas freedom from mitral valve reoperation at 1 and 5 years was 96.3% and 93.2%, respectively. Conclusions. This present study shows good early and long-term results in higher-risk patients undergoing minimally invasive surgery for mitral valve infective endocarditis. Total body, vascular, and echocardiographic screening represent the key points to select the optimal approach and allow for the extension of indications for minimally invasive surgery to sicker patients, including active endocarditis and sepsis.

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Section: Discussionmentioning

confidence: 99%

Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis

Barbero,

Pocar,

Brenna

et al. 2023

Medicina

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“…Echocardiography is the cornerstone of PVE diagnosis but can be inconclusive in up to 30% [ 2 ]. 3D-TEE provide additional information to guide diagnosis and therapeutic decisions by allowing a more realistic view of vegetations and abscesses, their location with regard to valve anatomy, and their relationship with surrounding tissues [ 7 ].…”

Section: Clinical Discussionmentioning

confidence: 99%

Multimodality imaging in the diagnosis of bioprosthetic aortic valve endocarditis: A case report

Bui

Duong

Vu³

et al. 2022

Annals of Medicine &Amp; Surgery

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“…In this setting, 3D-TEE is becoming an increasingly echocardiographic modality since it allows to manipulate and crop images in postprocessing; it enables an analysis of deep and sheltered anatomical structures by providing additional valuable information in PVE assessment. [ 8 9 ] Moreover, 3D-TEE visualization is not limited to conventional 2D planar views [Figures 7 and 8 ]. The possibility for further rotation and angulation allows 3D-TEE assessment of any heart structure from numerous planes and angles.…”

Section: T Hree-dimensional T Ransesopha...mentioning

confidence: 99%

Three-dimensional Transesophageal Echocardiography in Infective Endocarditis: What Does It Add?

Sordelli,

Weisz,

Fele

et al. 2024

Journal of Cardiovascular Echography

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Infective endocarditis (IE) diagnosis is based on a clinical suspicion supported by consistent microbiological and instrumental data. Evidence of involvement of cardiac valves (native or prosthetic) or prosthetic intracardiac material is a major diagnostic criterion of IE. Transthoracic echocardiography (TTE) is the initial technique of choice for the diagnosis while transesophageal echocardiography (TEE) is recommended in patients with an inconclusive or negative TTE, in patients with high suspicion of IE, as well as in patients with a positive TTE, in order to document local complications. Repeating TTE and/or TEE should be considered during follow-up of uncomplicated IE, in order to detect new silent complications and monitor vegetation size. In the setting of IE, the role of three-dimensional (3D) TEE is increasing; in fact, this technique has also been shown to be useful for the diagnosis of IE and its complications as it allows to obtain infinite planes and volumetric reconstructions. In this review, we will describe the usefulness of 3D-TEE and its added value in the management of IE.

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Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review

Cited by 8 publications

References 21 publications

Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis

Minimally Invasive Surgery: Standard of Care for Mitral Valve Endocarditis

Multimodality imaging in the diagnosis of bioprosthetic aortic valve endocarditis: A case report

Three-dimensional Transesophageal Echocardiography in Infective Endocarditis: What Does It Add?

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