Incremental Role of Three‐Dimensional Transesophageal Echocardiography in the Assessment of Mitral‐Aortic Intervalvular Fibrosa Abscess

Sadat, Kamel; Joshi, Deepak; Sudhakar, Selvin; Bicer, Elif Ijlal; Ibrahim, Hisham; Nanda, Navin C.; Bhagatwala, Kunal; Karia, Nidhi; Pandey, Abhilasha

doi:10.1111/j.1540-8175.2012.01672.x

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Pathologic conditions involving the area usually occur as a complication of infective endocarditis after aortic or mitral valve surgery and cause valvar regurgitation, dehiscence, abscess, and pseudoaneurysm, with the potential for communication with the transverse sinus or atrial rupture (29)(30)(31)(32) (Fig 11). The area can also be fractured or torn during percutaneous aortic valvoplasty and transcatheter aortic valve replacement (TAVR) (33), although this is rare.…”

Section: Fibrous Aortic-mitral Continuitymentioning

confidence: 99%

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

et al. 2017

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The fibrous skeleton is concentrated at the base of the ventricular mass. It provides electrical insulation at the atrioventricular level and fibrous continuity for the leaflets of the mitral, aortic, and tricuspid valves. Its components include the fibrous trigones, the fibrous area of aortic-mitral continuity, the subvalvar collar of the mitral valve, the membranous septum, the interleaflet triangles, the tendon of Todaro, and likely the conus ligament. The majority of the mitral annulus is fibrous, but the only true fibrous part of the tricuspid annulus is where the valvar leaflets are attached to the central fibrous body. At the aortic annulus, the fibrous elements support only the noncoronary aortic sinus and parts of the right and left coronary sinuses. The ring-shaped annulus of the arterioventricular valves as localized with imaging techniques (imaging annulus) differs from the crown-shaped hemodynamic annulus of the arterial valves. The imaging annulus corresponds to the plane passing through the nadirs of the hinge-lines of the leaflets. The hinges of the pulmonary valve are not part of the fibrous skeleton. Computed tomography (CT) and magnetic resonance (MR) imaging are excellent modalities for evaluation of the anatomy, physiologic variations, and pathologic conditions of the fibrous skeleton. The submillimeter isotropic three-dimensional datasets obtained with CT and the high contrast resolution of MR imaging are the main advantages of these modalities in assessing anatomy. The function of the valves and associated annuli can best be studied with MR imaging. Pathologic conditions involving the area, including paravalvar leaks, abscesses, perforation, and pseudoaneurysms, usually occur as a complication of infective endocarditis or extensive calcifications after valvar surgery. MR imaging and CT can demonstrate these lesions equally well. CT is the preferred technique for showing the extent of calcifications in the fibrous skeleton. Large calcifications involving the central fibrous body can cause heart block by interfering with the normal function of the His bundle and its branches. RSNA, 2017.

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Section: Fibrous Aortic-mitral Continuitymentioning

confidence: 99%

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

et al. 2017

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“…All these findings allow the differential diagnosis of PA‐MAIVF . Real time 3D echocardiography is a novel noninvasive imaging technique that is complementary to 2D imaging in the assessment of cardiovascular function and anatomy and PA‐MAIVF has recently been demonstrated by 3D echocardiography in a case report …”

Section: Discussionmentioning

confidence: 92%

Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral‐Aortic Intervalvular Fibrosa

et al. 2013

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Pseudoaneurysm of mitral-aortic intervalvular fibrosa (PA-MAIVF) is a rare complication of native aortic valve endocarditis. This region is a relatively avascular area and prone to infection during endocarditis and subsequent aneurysm formation. The rupture into the pericardial cavity and left atrium or aorta, systemic embolism, myocardial infarction secondary to left coronary compression, and sudden death are the reported complications. Herein, we present a 9-year-old boy who was diagnosed with bicuspid aortic valve endocarditis complicated by PA-MAIVF, cerebral embolism, and hemorrhage. PA-MAIVF was visualized by both two- and three-dimensional transthoracic echocardiography and ruptured into pericardial space causing a fatal outcome.

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“…Especially in patients with persistent fever and bacteremia, suspicion of perivalvular complications such as abscess formation, pseudoaneurysms, and fistulization should be high. 3DTEE has been shown to be useful in the detection of mitral paravalvular, mitral‐aortic intervalvular fibrosa, and prosthetic valve abscesses . However, to our knowledge, there is no study describing tricuspid perivalvular abscess in IE.…”

Section: Discussionmentioning

confidence: 98%

“…3DTEE has been shown to be useful in the detection of mitral paravalvular, mitral-aortic intervalvular fibrosa, and prosthetic valve abscesses. [17][18][19] However, to our knowledge, there is no study describing tricuspid perivalvular abscess in IE. Our 3DTEE study encountered one tricuspid perivalvular abscess of our 10 cases (Case 2), which was missed by 2DTEE.…”

Section: Discussionmentioning

confidence: 99%

The Advantages of Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Assessment of Tricuspid Valve Infective Endocarditis

et al. 2014

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Currently, tricuspid valve infective endocarditis (TVIE) is encountered in daily clinical practice more frequently due to the increasing prevalence of illicit intravenous drug use and the implantation of intracardiac devices. In this study, we compared findings from intra-operative live/real time three-dimensional transesophageal echocardiograms (3DTEE) and two-dimensional transesophageal echocardiograms (2DTEE) of 10 patients who underwent surgery for native tricuspid valve (TV) endocarditis. Unlike 2DTEE, 3DTEE allowed en face visualization of the 3 TV leaflets from both, atrial and ventricular aspects, in 9 of the 10 cases. In the remaining patient, in whom 3DTEE could not identify all 3 leaflets en face, the TV was found essentially destroyed at surgery. Using 3DTEE, the number of vegetations was accurately reported when compared with the surgical record. Furthermore, the orientation of each vegetation was the same as noted in the surgical findings. 2DTEE missed the identification of vegetations in 5 patients. The attachment site of vegetations to the TV were also not characterized by 2DTEE in 5 patients. In all 10 cases, 3DTEE characterized the vegetations more accurately with larger dimensions, including those in the azimuthal axis, and volumes. In addition, a perivalvular abscess that lead to surgical intervention was identified by 3DTEE, however, missed by 2DTEE. In conclusion, 3DTEE allows en face visualization of the TV apparatus permitting accurate description of the number and dimensions of vegetations identified by our surgical standard, which ultimately informs patients' prognosis and dictates the timing and planning for surgical intervention. Its use should be in conjunction with 2DTEE when evaluating TVIE.

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Incremental Role of Three‐Dimensional Transesophageal Echocardiography in the Assessment of Mitral‐Aortic Intervalvular Fibrosa Abscess

Cited by 6 publications

References 8 publications

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

Fibrous Skeleton of the Heart: Anatomic Overview and Evaluation of Pathologic Conditions with CT and MR Imaging

Native Aortic Valve Endocarditis Complicated by Pseudoaneurysm of Mitral‐Aortic Intervalvular Fibrosa

The Advantages of Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Assessment of Tricuspid Valve Infective Endocarditis

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