Author + information
- Tasneem Z. Naqvi, MD⁎ (, )
- Reza Rafie, MD and
- Mohammad Ghalichi, MD
- ↵⁎Address for correspondence:
Dr. Tasneem Z. Naqvi, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033
precise assessment of location of vegetation may be challenging in the presence of pacemaker and intracardiac defibrillator leads as well as tricuspid annuloplasty ring or bioprosthetic tricuspid valve by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE), due to reverberation artifact produced by the catheter and prosthetic valve material. Identification of location of the vegetation on the lead versus prosthetic valve has therapeutic implications, particularly in patients with multiple prior cardiac surgeries in whom repeat surgery is not desirable. Cardiac magnetic resonance is currently not a feasible imaging option in patients with prosthetic devices. Real-time 3-dimensional transesophageal echocardiography (RT3D TEE) is able to demonstrate precise relationships among various anatomical structures and is also able to visualize intracardiac catheters, including catheter tip, without artifact associated with TTE and conventional TEE. The utility of RT3D TEE in suspected right-sided endocarditis in patients with pacemaker or intracardiac leads and bioprosthetic tricuspid valve or a tricuspid annuloplasty ring is described in this report. It is to be emphasized that lack of demonstrable vegetations by RT3D TEE may not necessarily imply lack of infection of the device.
RT3D TEE allows evaluation of precise location of vegetation on prosthetic devices such as intracardiac defibrillator (ICD) leads, pacemakers, or tricuspid valve prostheses. Precise delineation of location of vegetation in these patients allows therapeutic medical and surgical treatment decisions. Absence of demonstrable vegetations by RT3D TEE however does not entirely exclude endocarditis, which ultimately remains a clinical diagnosis.
- American College of Cardiology Foundation