Sungur Aylin, Hsiung Ming C, Meggo Quiroz Luis D, Oz Tuğba Kemaloğlu, Haj Asaad Ayman, Joshi Deepak, Dönmez Cevdet, Güvenç Tolga S, Nanda Navin C
Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
Echocardiography. 2014 Nov;31(10):1293-309. doi: 10.1111/echo.12785. Epub 2014 Sep 25.
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.
目前，由于非法静脉药物使用的增加和心内装置的植入，三尖瓣感染性心内膜炎（TVIE）在日常临床实践中更为常见。在本研究中，我们比较了10例接受原发性三尖瓣（TV）心内膜炎手术患者的术中实时三维经食管超声心动图（3DTEE）和二维经食管超声心动图（2DTEE）的检查结果。与2DTEE不同，在10例患者中的9例中，3DTEE能够从心房和心室两个方面对3个TV瓣叶进行正面可视化。在其余1例患者中，3DTEE无法从正面识别所有3个瓣叶，术中发现该TV基本已被破坏。使用3DTEE时，与手术记录相比，赘生物的数量能够被准确报告。此外，每个赘生物的方位与手术结果一致。2DTEE在5例患者中未发现赘生物。在5例患者中，2DTEE也未明确赘生物在TV上的附着部位。在所有10例病例中，3DTEE能够更准确地描述赘生物的特征，包括更大的尺寸，如方位轴上的尺寸和体积。此外，3DTEE发现了导致手术干预的瓣周脓肿，但2DTEE未发现。总之，3DTEE能够对TV装置进行正面可视化，从而根据我们的手术标准准确描述赘生物的数量和尺寸，这最终有助于判断患者的预后并决定手术干预的时机和方案。在评估TVIE时，应将3DTEE与2DTEE联合使用。
