The Value of Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Assessment of Valvular Vegetations

Hansalia, Sachin; Biswas, Monodeep; Dutta, Rajarshi; Hage, Fadi G.; Hsiung, Ming C.; Nanda, Navin C.; Singh, Preeti; Manda, Jayaprakash; Kesanolla, Saritha Kumari; Wei, Jeng; Yin, Wei Hsian

doi:10.1111/j.1540-8175.2009.01042.x

Cited by 65 publications

(59 citation statements)

References 24 publications

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“…Therefore, the study findings are of clinical relevance and add to previous studies in general populations and 5 isolated case reports of Libman-Sacks endocarditis on the complementary value of 3D-TEE to 2D-TTE or 2D-TEE for the detection, characterization, and differentiation of non-infective and infective vegetations, valve tumors, thrombus, and nodular calcifications (13–16,23–28,). Also, 3D-TEE may have additive complementary value to 2D-TEE in the diagnosis of embolic cerebrovascular disease in SLE.…”

Section: Discussionsupporting

confidence: 73%

“…Multiplane two-dimensional (2-D) transesophageal echocardiography (TEE) has high diagnostic value for detection of Libman-Sacks endocarditis (5,6,8,12). Three-dimensional TEE (3D-TEE) has emerged as an important complementary technique to 2D-TEE for detection and characterization of infective vegetations and valve tumors (13–16). However, no previous study has been reported on the diagnostic value and clinical relevance of 3D-TEE in Libman-Sacks endocarditis.…”

Section: Introductionmentioning

confidence: 99%

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Libman-Sacks Endocarditis: Detection, Characterization, and Clinical Correlates by Three-Dimensional Transesophageal Echocardiography

Roldan

Tolstrup

Macias

et al. 2015

Journal of the American Society of Echocardiography

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Background Libman-Sacks endocarditis, characterized by Libman-Sacks vegetations, is common in patients with systemic lupus erythematosus (SLE), and is commonly complicated with embolic cerebrovascular disease. Thus, accurate detection of Libman-Sacks vegetations may lead to early therapy and prevention of their associated complications. Although two-dimensional transesophageal echocardiography (2D-TEE) has high diagnostic value for detection of Libman-Sacks vegetations, three-dimensional TEE (3D-TEE) may allow improved detection, characterization, and clinical correlations of Libman-Sacks vegetations. Methods 29 SLE patients (27 women, age 34±12 years) prospectively underwent 40 paired 3D-TEE and 2D-TEE studies and assessment of cerebrovascular disease manifested as acute clinical neurologic syndromes, neurocognitive dysfunction, or focal brain injury on MRI. Initial and repeat studies in patients were intermixed in a blinded manner with paired studies from healthy controls, de-identified, coded, and independently interpreted by experienced observers unaware of patients’ clinical and imaging data. Results 3D-TEE as compared to 2D-TEE studies were more often positive for mitral or aortic valve vegetations, detected more vegetations per study, and determined larger size of vegetations (all p≤0.03). Also, 3D-TEE detected more vegetations on the anterior mitral leaflet, anterolateral and posteromedial scallops, and ventricular side or both atrial and ventricular sides of the leaflets (all p<0.05). In addition, 3D-TEE detected more vegetations on the aortic valve left and non-coronary cusps, coronary cusps’ tip and margins, and aortic side or both aortic and ventricular sides of the cusps (all p≤0.01). Furthermore, 3D-TEE detected more often associated mitral or aortic valves’ commissural fusion (p=0.002). Finally, 3D-TEE detected more vegetations in patients with cerebrovascular disease (p=0.01). Conclusion 3D-TEE provides clinically relevant additive information that complements 2D-TEE for the detection, characterization, and association with cerebrovascular disease of Libman-Sacks endocarditis.

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Section: Discussionsupporting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Libman-Sacks Endocarditis: Detection, Characterization, and Clinical Correlates by Three-Dimensional Transesophageal Echocardiography

Roldan

Tolstrup

Macias

et al. 2015

Journal of the American Society of Echocardiography

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“…In this regard, early investigations 64,65 of 3D TEE have demonstrated advantages over 2-dimensional TEE (which is routinely used) to better detect and delineate vegetations and to identify IE complications and their relationships with surrounding structures. Unfortunately, the lower temporal and lateral resolution with 3D echocardiography compared with 2-dimensional echocardiography leads to an overestimation of vegetation size and technically challenging visualization of fast-moving structures.…”

Section: D Echocardiography and Other Imaging Modalitiesmentioning

confidence: 99%

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Baddour¹,

Wilson²,

Bayer³

et al. 2015

Circulation

2,537

1,421

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Background— Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today’s myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. Methods and Results— This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. Conclusions— Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.

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“…Komplementär zu den bewährten Modalitäten kann die Echtzeit-3-D-Echokardiographie ergänzen-de Hinweise zu Vegetationsgröße, Abszessausbreitung und Chordarupturen liefern [12,13]. Diese Informationen können für die Operationsplanung wichtig werden und eine Risikoabschätzung bezüglich des Auftretens von Embolien erlauben.…”

Section: Echokardiographieunclassified

Infektiöse Endokarditis

2016

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Infective endocarditis is an endovascular infection usually caused by bacteria. Mortality rate is still approximately 20 %. To improve patients' prognosis by implementation of current diagnostic and therapeutic evidence, the European Society of Cardiology published an updated version of the guidelines for management of infective endocarditis in 2015. It strengthens the role of imaging modalities like PET/CT for detection of infectious foci when echocardiography remains negative and highlights the use of modern tests for identification of possible pathogens. New diagnostic criteria were introduced to integrate these methods for improved diagnostic sensitivity. Complicated cases should be treated in reference centers with on-site cardiac surgery. The antibiotic and early surgical management should be discussed in a multidisciplinary endocarditis team. A few years ago, the indication for endocarditis prophylaxis was limited to high-risk patients. These recommendations were confirmed in current guidelines.

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The Value of Live/Real Time Three‐Dimensional Transesophageal Echocardiography in the Assessment of Valvular Vegetations

Cited by 65 publications

References 24 publications

Libman-Sacks Endocarditis: Detection, Characterization, and Clinical Correlates by Three-Dimensional Transesophageal Echocardiography

Libman-Sacks Endocarditis: Detection, Characterization, and Clinical Correlates by Three-Dimensional Transesophageal Echocardiography

Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications

Infektiöse Endokarditis

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