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The Additional Value of Three‐Dimensional Transesophageal Echocardiography in Complex Aortic Prosthetic Heart Valve Endocarditis
Author(s) -
Tanis Wilco,
Teske Arco J.,
Herwerden Lex A.,
Chamuleau Steven,
Meijboom Folkert,
Budde Ricardo P.J.,
Cramer MaartenJan
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12602
Subject(s) - medicine , endocarditis , coronary arteries , radiology , cardiology , coronary artery disease , aortic valve , artery
Background Two‐dimensional transthoracic and transesophageal echocardiography (2D TTE and 2D TEE ) may fail to detect signs of prosthetic heart valve ( PHV ) endocarditis due to acoustic shadowing. Three‐dimensional (3D) TEE may have additional value; however, data are scarce. This study was performed to investigate the additional value of 3D TEE for the detection of aortic PHV endocarditis and the extent of the disease process. Methods Retrospective analysis of complex aortic PHV endocarditis cases that underwent 2D TTE , 2D TEE , and 3D TEE before surgery. Echocardiograms were individually assessed by 2 cardiologists blinded for the outcome. Surgical and pathological inspection served as the reference standard for vegetations and peri‐annular extensions (abscesses/mycotic aneurysms). To determine if the proximal coronary arteries were involved in the inflammatory process as well, computed tomography angiography findings were added to reference standard. Results Fifteen aortic PHV endocarditis cases were identified. According to the reference standard, all 15 cases had peri‐annular extensions, 13 of which had a close relationship with the proximal right and/or left coronary artery. In 6 of 15 patients, a vegetation was present. Combined 2D TTE / TEE missed 1/6 vegetations and 1/15 peri‐annular extensions. After addition of 3D TEE , all vegetations (6/6) and peri‐annular extensions (15/15) were detected, without adding false positives. Compared to 2D TEE , in 3/15 cases, 3D TEE resulted in better delineation of the anatomical relationship of the proximal coronary arteries to the peri‐annular extensions. As a result, 3D TEE had an additional value in 5/15 cases. Conclusion In complex aortic, PHV endocarditis 3D TEE may have additional value compared to 2D echocardiography.