Author + information
- Fernando De Torres-Alba, MD∗∗ (, )
- Teresa López-Fernández, MD∗,
- Ulises Ramírez-Valdiris, MD†,
- Silvia Valbuena-López, MD∗,
- Ángel Manuel Iniesta-Manjavacas, MD∗,
- Nieves Montoro-López, MD∗,
- Mar Moreno-Yangüela, MD, PhD∗,
- José María Mesa-García, MD† and
- José López-Sendón, MD, PhD∗
- ∗Department of Cardiology, La Paz University Hospital, Madrid, Spain
- †Department of Cardiac Surgery, La Paz University Hospital, Madrid, Spain
- ↵∗Address for correspondence:
Dr. Fernando De Torres-Alba, Department of Cardiology, La Paz University Hospital, C/Castrillo de Aza n°3, dcha. 4° B, 28031 Madrid, Spain.
PERIVALVULAR EXTENSION IS THE MOST FREQUENT CAUSE OF UNCONTROLLED INFECTION in patients with infective endocarditis (IE), and extension to the mitral-aortic intervalvular fibrosa (MAIVF) occurs in 30% of patients undergoing surgery for IE (1). The MAIVF is a thin, relatively avascular fibrous structure between the fibrous trigones that connects the anterior mitral leaflet with the left ventricle outflow tract. The surgical technique described by David et al. (2), consisting of radical resection and debridement of all infected tissues and reconstruction with pericardium, is a complex procedure, but renders excellent results in terms of eradicating infection. Real-time 3-dimensional transesophageal echocardiography allows the acquisition of outstanding anatomical images, even in the presence of prosthetic valves, and it is useful in the perioperative setting, allowing immediate feedback on the effectiveness of interventions. In this Imaging Vignette (Figs. 1 to 6⇓⇓⇓⇓⇓⇓, Online Videos 1, 2, 3, 4, 5, 6, and 7), we address the challenges and the advantages of real-time 3-dimensional transesophageal echocardiography in patients with IE involving the MAIVF.
For supplementary videos and their legends, please see the online version of this article.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2013 American College of Cardiology Foundation