The additional value of three-dimensional transesophageal echocardiography in complex aortic prosthetic heart valve endocarditis.
BACKGROUND
Two-dimensional transthoracic and transesophageal echocardiography (2DTTE and 2DTEE) 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 3DTEE 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 2DTTE, 2DTEE, and 3DTEE 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 2DTTE/TEE missed 1/6 vegetations and 1/15 peri-annular extensions. After addition of 3DTEE, all vegetations (6/6) and peri-annular extensions (15/15) were detected, without adding false positives. Compared to 2DTEE, in 3/15 cases, 3DTEE resulted in better delineation of the anatomical relationship of the proximal coronary arteries to the peri-annular extensions. As a result, 3DTEE had an additional value in 5/15 cases.


CONCLUSIONS
In complex aortic, PHV endocarditis 3DTEE may have additional value compared to 2D echocardiography.
Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands.
Wilco
W
Tanis
Arco J
AJ
Teske
Lex A
LA
van Herwerden
Steven
S
Chamuleau
Folkert
F
Meijboom
Ricardo P J
RP
Budde
Maarten-Jan
MJ
Cramer
D000368:Aged; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000601:surgery; D019560:Echocardiography, Three-Dimensional / Q000379:methods; D017548:Echocardiography, Transesophageal / Q000379:methods; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000209:etiology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
aortic prosthetic heart valve; endocarditis; three-dimensional transesophageal echocardiography; two-dimensional transesophageal echocardiography; two-dimensional transthoracic echocardiography