scholarly journals P202 Two-dimensional and three-dimensional transesophageal echocardiography in the diagnosis of infective endocarditis of native and prosthetic valves

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
L Capotosto ◽  
G Tanzilli ◽  
E Mangieri ◽  
M R Ciardi ◽  
C Gaudio ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Prosthetic Valve ◽  
Three Dimensional ◽  
Valve Prosthesis ◽  
Two Dimensional ◽  
Chordae Tendineae ◽  
Native Valve ◽  
Prosthetic Valves ◽  
Sensitivity Specificity

Abstract Purpose The purpose of this study was to examine the incremental value of three-dimensional transesophageal echocardiography (3D-TEE) compared to two-dimensional transesophageal echocardiography (2D-TEE) in the diagnosis of infective endocarditis (IE) of native and prosthetic valves. Methods Forty-three patients with clinically suspected IE were studied. The patients had clinical, microbiological and echocardiographic assessment to establish a diagnosis of IE in accordance to current guidelines recommendations. Presence, location and size of vegetations, new or progressive valve regurgitation, possible chordae tendineae rupture, paravalvular extension, and new dehiscence of a valve prosthesis were assessed by echocardiography. Results In 25 (58%) patients the diagnosis of IE was established. Thirteen patients had native valves and 12 patients had prosthetic valves (9 mechanical, 3 biological). 2D-TEE and 3D-TEE showed a sensitivity, specificity, positive and negative predictive value for diagnosis of IE of 91% and 89%, 88% and 91%, 84% and 86%, and 93% and 90%, respectively, in native valves, and of 92 and 90% 91% and 97% (p = 0.002), 84% and 82% and 89% and 95% (p = 0.01), respectively, in patients with prosthetic valves. Major vegetation diameter was 18mm for 3D-TEE and 16mm for 2D-TEE in native valves and 19mm for 3D-TEE and 14mm for 2D-TEE in prosthetic valves (p = 0.04). Peri-annular extension was detected by any of the echocardiographic modalities in three patients with native valve IE and two patients with prosthetic valves, and by 3D-TEE only and not by 2D-TEE in one patient with prosthetic valve. Conclusions Patients with prosthetic valve infective endocarditis seem to have more additive benefit from 3D-TEE compared to patients with native valve IE.

scholarly journals Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review

Medicina ◽  
2021 ◽  
Vol 58 (1) ◽  
pp. 23
Author(s):  
Vedran Carević ◽  
Zorica Mladenović ◽  
Ružica Perković-Avelini ◽  
Tina Bečić ◽  
Mislav Radić ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Prosthetic Valve ◽  
Three Dimensional ◽  
Prosthetic Valve Endocarditis ◽  
Valve Surgery ◽  
Optimal Time ◽  
Imaging Method ◽  
Fatal Complication ◽  
Native Valve ◽  
Surgical Interventions

Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application.

Three-dimensional compared to two-dimensional transesophageal echocardiography for diagnosis of infective endocarditis

Infection ◽  
2016 ◽  
Vol 44 (6) ◽  
pp. 725-731 ◽  
Author(s):  
Roman Pfister ◽  
Yann Betton ◽  
Henrik ten Freyhaus ◽  
Norma Jung ◽  
Stephan Baldus ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Transesophageal Echocardiography ◽  
Three Dimensional ◽  
Two Dimensional

Abstract 13434: Improved Diagnostic Performance of Contemporary Transesophageal Echocardiography With Three-dimensional Imaging for Infective Endocarditis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Johnny Chahine ◽  
Bryce Montane ◽  
Jafar Alzubi ◽  
Hanan Alnajjar ◽  
Andrew Fiore ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Diagnostic Performance ◽  
3D Imaging ◽  
Statistical Significance ◽  
Three Dimensional ◽  
Prosthetic Graft ◽  
High Morbidity ◽  
Native Valve ◽  
Duke Criteria

Introduction: Infective endocarditis (IE) is associated with high morbidity and mortality. Conventionally, a repeat transesophageal echocardiogram (TEE) is necessary if the first TEE is negative, and there is high clinical suspicion. We aimed to investigate the diagnostic performance of contemporary TEE for IE. Hypothesis: We hypothesize that with advancements in TEE imaging, including three-dimensional (3D) imaging, the diagnostic performance of TEE for IE would be improved. Methods: Patients who had two or more TEEs at our center, within 6 months, for evaluation of IE in 2011 (pre-3D imaging) and 2019 (post-3D imaging) were included. Patients not meeting the Duke criteria for IE (n=899) were excluded. The primary endpoint was the sensitivity of TEE to detect IE. TEE sensitivity was also compared among the different subtypes of IE (native valve, prosthetic valve, device-related, central line-related, and aortic prosthetic graft-related). Results: 242 patients were included: 70 in 2011 and 172 in 2019. In 2011, there were more smokers and a lower rate of pacing devices; otherwise, there were no significant differences in baseline characteristics, including intravenous drug use. The sensitivity of the initial TEE for IE was 85.7% in 2011, improving significantly to 95.3% in 2019 (p=0.01). The improved diagnostic performance in 2019 was mainly driven by the improved detection of prosthetic valve IE (70.8% vs. 93.7%, p=0.009). There were no significant differences for the other subtypes of IE (Figure). In 2019, patients had a higher rate of IE diagnosis within 15 days of index admission, which did not reach statistical significance (n=161, 93.6% vs. n=62, 88.6% in 2011, p=0.19). Kaplan Meier analysis demonstrated that patients in 2019 had a higher rate of procedures for endocarditis (p=0.01). Conclusions: Contemporary TEE imaging including 3D technology improved the detection of IE on the initial TEE, mainly driven by improved detection of prosthetic valve IE.

Abstract 12852: The Incremental Value of Three-Dimensional Transesophageal Echocardiography for the Diagnostic Assessment of Infective Endocarditis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Fabio Chirillo ◽  
Marta Possamai ◽  
Matteo Rugolotto ◽  
Paola Martire ◽  
Giuseppe Minniti ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Mitral Valve Repair ◽  
Three Dimensional ◽  
Anatomical Location ◽  
Maximal Dimension ◽  
Valve Repair ◽  
Prosthetic Valves ◽  
Icd Leads

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

The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

2020 ◽  
Vol 21 (12) ◽  
pp. 1140-1153 ◽  
Author(s):  
Mohammad A. Noshak ◽  
Mohammad A. Rezaee ◽  
Alka Hasani ◽  
Mehdi Mirzaii
Keyword(s):  
Foreign Body ◽  
Infective Endocarditis ◽  
Prosthetic Valve ◽  
Human Life ◽  
Prosthetic Valve Endocarditis ◽  
Surgical Site Infections ◽  
Coagulase Negative Staphylococci ◽  
Native Valve ◽  
Native Valve Endocarditis

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

scholarly journals Infective endocarditis caused by HACEK group bacteria—a registry-based comparative study

2021 ◽  
Author(s):  
Anna Bläckberg ◽  
Christian Morenius ◽  
Lars Olaison ◽  
Andreas Berge ◽  
Magnus Rasmussen
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Haemophilus Influenzae ◽  
Comparative Study ◽  
Clinical Characteristics ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Common Cause ◽  
Prosthetic Valves

AbstractInfective endocarditis (IE) caused by bacteria within Haemophilus (excluding Haemophilus influenzae), Aggregatibacter, Cardiobacterium, Eikenella and Kingella (HACEK) is rare. This study aimed to describe clinical features of IE caused by HACEK genera in comparison with IE due to other pathogens. Cases of IE due to HACEK were identified through the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of IE cases caused by HACEK were compared with cases of IE due to other pathogens reported to the same registry. Ninety-six patients with IE caused by HACEK were identified, and this corresponds to 1.8% of all IE cases. Eighty-three cases were definite endocarditis, and the mortality rate was 2%. The median age was 63 years, which was lower compared to patients with IE caused by other pathogens (66, 70 and 73 years respectively, p ≤ 0.01). Patients with IE caused by Haemophilus were younger compared to patients with IE due to Aggregatibacter (47 vs 67 years, p ≤ 0.001). Patients with IE due to HACEK exhibited longer duration from onset of symptoms to hospitalization and had more prosthetic valve endocarditis compared to patients with IE due to Staphylococcus aureus (10 vs 2 days, p ≤ 0.001, and 35 vs 14%, p ≤ 0.001). This is, to date, the largest study on IE due to HACEK. Aggregatibacter was the most common cause of IE within the group. The condition has a subacute onset and often strikes in patients with prosthetic valves, and the mortality rate is relatively low.

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