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

Figures

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  Figure 1. Transesophageal echocardiography of MVP: Presentation of the MVP in different two-dimensional planes needs careful mental reconstruction to translate the echo description into the anatomy (a–c); 3D TEE reconstruction allows realistic anatomic image of the MVP similar to the one the surgeon sees from the LA (surgeon’s view) (d); cropped and enlarged 3D TEE image allows better presentation of the MVP and surrounding structures (white arrow—residual tissue of posterior leaflet of native mitral valve) (e); schematic presentation of surgeon’s view (clockwise orientation) with AV anteriorly at 12 o’clock position, IAS at the middle 3 o’clock position, and LAA at the lateral 9 o’clock position (f). AV—aortic valve; IAS—interatrial septum; LA—left atrium; LAA- left atrium appendage; LV—left ventricle; MVP—mitral valve prosthesis; and 3D TEE—three-dimensional echocardiography.

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  Figure 2. Transesophageal echocardiography of mechanical MVP endocarditis caused with Staphylococcus aureus: 2D TEE showed an extensive vegetation (white arrows) attached to the prosthetic ring and leaflets (a,b); 3D TEE showed voluminous vegetation (asterisks) affecting a whole circumference of sewing ring and MVP leaflets (c—in systole, d—in diastole). 2D TEE—two-dimensional transesophageal echocardiography; 3D TEE—three-dimensional transesophageal echocardiography; LA—left atrium; PVE—prosthetic valve endocarditis; and MVP—mitral valve prosthesis.

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  Figure 3. Transesophageal echocardiography of mitral bioprosthesis endocarditis caused by Enterococcus faecalis: 2D TEE (a) and 3D TEE view (b,c) from the atrial side showed a sedentary type of vegetation (white arrow) clinging to the leaflet with a wide base; view from the left ventricle showed good leaflet appearance and coaptation with no possible complications of PVE (d). 2D TEE—two-dimensional transesophageal echocardiography; 3D TEE—three-dimensional transesophageal echocardiography; PVE—prosthetic valve endocarditis; LA—left atrium; and LV—left ventricle.

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  Figure 4. Transesophageal echocardiography of MVP endocarditis caused by Streptococcus bovis. Two-dimensional TEE shoved localized dehiscence of the MVP with a paravalvular leakage (white arrow) (a,b); surgeon’s view of MVP with suspected dehiscence (white arrow) in the lateral (8–9 o’clock) position (c); enlarged and rotated 3D TEE image from different angle confirms a defect (white arrow) with fairly large surface area that occupies approximately 15% of the MVP circumference and causes hemodynamically significant regurgitation (d). 2D TEE—two-dimensional transesophageal echocardiography; 3D TEE—three-dimensional transesophageal echocardiography; MVP—mitral valve prosthesis; LA—left atrium; and LV—left ventricle.

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  Figure 5. Transesophageal echocardiography of the mitral valve 15 days after surgical correction due to mitral valve prolapse. Two-dimensional TEE revealed dehiscence of the C-E ring with consequent severe regurgitation (white arrow, a,b); 3D TEE showed almost complete dehiscence of the C-E ring which was attached to the native ring only on the smaller posterolateral segment (white arrow); the asterisk indicates the surface of the native mitral orifice (c—in systole, d—in diastole). Clinical and laboratory parameters along with Staphylococcus epidermidis revealed in blood culture suggest that dehiscence was caused by infective endocarditis. 2D TEE—two-dimensional transesophageal echocardiography; 3D TEE—three-dimensional transesophageal echocardiography; C-E—Carpentier-Edwards ring; LA—left atrium; and LV—left ventricle.