title: The advantages of live/real time three-dimensional transesophageal echocardiography in the assessment of tricuspid valve infective endocarditis.
abstract: Currently, tricuspid valve infective endocarditis (TVIE) is encountered in daily clinical practice more frequently due to the increasing prevalence of illicit intravenous drug use and the implantation of intracardiac devices. In this study, we compared findings from intra-operative live/real time three-dimensional transesophageal echocardiograms (3DTEE) and two-dimensional transesophageal echocardiograms (2DTEE) of 10 patients who underwent surgery for native tricuspid valve (TV) endocarditis. Unlike 2DTEE, 3DTEE allowed en face visualization of the 3 TV leaflets from both, atrial and ventricular aspects, in 9 of the 10 cases. In the remaining patient, in whom 3DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3DTEE, the number of vegetations was accurately reported when compared with the surgical record. Furthermore, the orientation of each vegetation was the same as noted in the surgical findings. 2DTEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2DTEE in 5 patients. In all 10 cases, 3DTEE characterized the vegetations more accurately with larger dimensions, including those in the azimuthal axis, and volumes. In addition, a perivalvular abscess that lead to surgical intervention was identified by 3DTEE, however, missed by 2DTEE. In conclusion, 3DTEE allows en face visualization of the TV apparatus permitting accurate description of the number and dimensions of vegetations identified by our surgical standard, which ultimately informs patients' prognosis and dictates the timing and planning for surgical intervention. Its use should be in conjunction with 2DTEE when evaluating TVIE.
authors.affiliation: Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Aylin
authors.initials: A
authors.lastname: Sungur
authors.forename: Ming C
authors.initials: MC
authors.lastname: Hsiung
authors.forename: Luis D
authors.initials: LD
authors.lastname: Meggo Quiroz
authors.forename: Tuğba Kemaloğlu
authors.initials: TK
authors.lastname: Oz
authors.forename: Ayman
authors.initials: A
authors.lastname: Haj Asaad
authors.forename: Deepak
authors.initials: D
authors.lastname: Joshi
authors.forename: Cevdet
authors.initials: C
authors.lastname: Dönmez
authors.forename: Tolga S
authors.initials: TS
authors.lastname: Güvenç
authors.forename: Navin C
authors.initials: NC
authors.lastname: Nanda
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D015331:Cohort Studies; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery
keywords: endocarditis; live/real time three-dimensional transesophageal echocardiography; right-sided infective endocarditis; three-dimensional echocardiography; tricuspid valve; tricuspid valve infective endocarditis