The Advantages of Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Assessment of Tricuspid Valve Infective Endocarditis

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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 (3D TEE ) and two‐dimensional transesophageal echocardiograms (2D TEE ) of 10 patients who underwent surgery for native tricuspid valve ( TV ) endocarditis. Unlike 2D TEE , 3D TEE 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 3 DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3D TEE , 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. 2D TEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2D TEE in 5 patients. In all 10 cases, 3D TEE 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 3D TEE , however, missed by 2D TEE . In conclusion, 3D TEE 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 2D TEE when evaluating TVIE .

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