Incremental Value of Three‐Dimensional Transesophageal Echocardiography over Two‐Dimensional Transesophageal Echocardiography in the Assessment of Lambl's Excrescences and Nodules of Arantius on the Aortic Valve

Abstract

In this retrospective study, we identified 7 cases where Lambl's excrescences were identified by two-dimensional transesophageal echocardiography (2DTEE) and also had live/real time three-dimensional transesophageal echocardiography (3DTEE) studies available for comparison. We subsequently assessed them for the presence of Lambl's excrescences (LE) and nodules of Arantius (NA) on the aortic valve. After their identification, we qualitatively and quantitatively organized our findings by number, cusp location, measurements, and orientation if applicable. A greater number of LE was found by 3DTEE than 2DTEE (19 vs. 11, respectively). In all 3DTEE studies, their cusp attachment site, their x-, y-, and z-axis measurements, and orientation were clearly visualized and described. Only 3DTEE studies provided confident visualization of the cusp attachment sites. Similarly, a greater number of NA was found by 3DTEE than 2DTEE (21 vs. 5, respectively). The triad of NA was visualized in all 3DTEE studies and each was described using its x-, y-, and z- axis measurements. Only three 2DTEE studies provided reliable identification of the NA. In conclusion, we present further evidence of the incremental value of 3DTEE over 2DTEE in the qualitative and quantitative assessment of cardiac structures including LE and NA on the aortic valve.

Incremental Value of Live/Real Time Three‐Dimensional over Two‐Dimensional Transesophageal Echocardiography in the Assessment of Atrial Septal Pouch

“…As presented by our laboratory in prior 3DTEE studies, this modality has been able to acquire larger measurements in width (elevational dimension) in addition to height and length, which has allowed for the cal- culation of larger areas and volumes for different types of cardiac masses. [21][22][23] An ASP can be missed by 2DTEE as it occurred in three of our 34 single ASP cases and in three of our five double ASP cases. This scenario is a direct consequence associated with the 2D modality because of its single slice technique.…”

“…It is a retrospective study that identified patients who had undergone 3DTEE with visualization of an ASP and concomitantly had a 2DTEE during that same clinical encounter. As presented by our laboratory in prior 3DTEE studies, this modality has been able to acquire larger measurements in width (elevational dimension) in addition to height and length, which has allowed for the calculation of larger areas and volumes for different types of cardiac masses . An ASP can be missed by 2DTEE as it occurred in three of our 34 single ASP cases and in three of our five double ASP cases.…”

Lambl's Excrescences: Association with Cerebrovascular Disease and Pathogenesis

“…The detection of LEx is of particular importance in a relatively large proportion (~25%) of young patients with presumed cryptogenic stroke/TIA [31) in whom TEE is recommended. The detection of LEx in these patients, which will increase further with the use of three-dimensional TEE [32], may lead to misclassification of a stroke/TIA as cardioembolic, underdiagnosis of the true etiology of stroke/TIA, and potentially to unnecessary antiplatelet or anticoagulant therapy or even valve surgery. Thus, detection of LEx in a patient with suspected cardioembolism should not be considered a de facto cause of cerebroembolism.…”

Three‐dimensional echocardiographic assessment of the aortic valve and the aorta

“…Compared to 2D echocardiography, 3D imaging can provide more accurate diagnostic information regarding the site, size, shape, and number of cardiac masses Table 1 29,30 …”