Abstract 12852: The Incremental Value of Three-Dimensional Transesophageal Echocardiography for the Diagnostic Assessment of Infective Endocarditis
Two-dimensional transesophageal echocardiography (2D TEE) may fail to detect signs of infective endocarditis (IE) or to delineate complex anatomic lesions due to suboptimal visualization of the infected area. Three-dimensional (3D) TEE may have additional value; however, data are scarce. In 124 consecutive patients (85 M; Mean age 63 ± 14 years) with definite IE involving the aortic (36), mitral (35), tricuspid (5), ≤ 1 valve (6), and prosthetic valves (30),or pace-maker/ICD leads (12) the comparative analysis between 2D and 3D imaging focused on: 1) Presence and maximal dimension of vegetations; 2) Prediction of embolic events; 3) Location and dimension of valve perforation; 3) Prediction of successful mitral valve repair; 4) Identification and morphologic assessment of perivalvular complications.3D TEE detected more vegetations per patient (1.9 ± 2.1 vs 1.7± 1.6; p= 0.06), but this difference was significant only for vegetations on prosthetic valves and PM/ICD leads (2.2 ± 1.7 vs 1.1 ± 1.5; p=0.03). TomTec Software was used to crop the 3D volume to obtain the largest value for vegetations and perforation area. The 3D TEE maximal vegetation dimension was larger with a mean difference of 2.9 mm (95% CI, 1.9-4.52 mm) vs 2DTEE. The best cut-off value for prediction of embolic events was ≥18 mm with 3D TEE and ≥14 mm with 2D TEE. The positive predictive value for 3D TEE was not statistically higher (58% vs 52%). Valve perforation was identified in 10/19 patients with 2D TEE and in 18/19 patients with 3D TEE (p< 0.007) with subsequent surgical confirmation. Successful mitral valve repair was associated with a distance of the perforation > 3 mm from the leaflet tip and from commisures. This information was provided only by 3D TEE. Finally, 2D TEE missed 2/20 peri-annular extensions. After addition of 3D TEE all peri-annular extensions (20/20) were detected, without adding false positives.In 5 patients contrast 3D TEE provided visualization of the full extent of the defect and its precise anatomical location, prior to successful surgical resection. In conclusion 3D TEE is a feasible technique for the analysis of vegetation size and complex cardiac lesions caused by IE that may overcome the limitations of 2D TEE, providing incremental information useful for surgery
Author Disclosures: F. Chirillo: None. M. Possamai: None. M. Rugolotto: None. P. Martire: None. G. Minniti: None. S. Giacomelli: None. P. Scotton: None. E. Polesel: None. Z. Olivari: None.
- © 2014 by American Heart Association, Inc.