Transesophageal echocardiographic identification of a vegetation due to a jet lesion

Atrial endocarditis--the importance of the regurgitant jet lesion

The jet lesions of valvular regurgitation or intracardiac shunts have been hypothesized to play an important role in the pathogenesis of endocarditis for many years. We describe a case of mitral valve endocarditis that involved the left atrium along the path of a jet lesion. This resulted in atrial endocarditis and pericarditis, both of which complicated her presentation and hospital course. Using transesophageal echocardiography, we were able to directly visualize the path and full extent of infection prior to surgery. Special attention should be focused upon the path of eccentric jets in order to fully define the extent of endocarditis.

Retinal hemorrhages from septic emboli in a patient with a ventricular false chorda

PURPOSE

To demonstrate ophthalmic findings of bacterial endocarditis in a patient with a cardiac structural anomaly and to illustrate the potential usefulness of transesophageal echocardiography in the examination of such patients.

METHODS

We examined a patient with bacteremia who had white-centered retinal hemorrhages. Complete clinical, laboratory, and echocardiographic evaluations were performed.

RESULTS

Streptococcal bacteremia was proven and, by using transesophageal echocardiography, a ventricular false chorda was demonstrated.

CONCLUSIONS

Patients with white-centered retinal hemorrhages should undergo thorough systemic examinations. In this unusual case of such hemorrhages caused by bacteremia in a patient with a ventricular false chorda, modern, high-resolution transesophageal echocardiography played an important role in confirming the diagnosis.

Diagnosis in adolescents and adults with congenital heart disease. Prospective assessment of individual and combined roles of magnetic resonance imaging and transesophageal echocardiography

BACKGROUND

The inability to obtain complete diagnoses with transthoracic echocardiography in many adults with congenital heart disease provided the incentive to evaluate prospectively the individual and combined roles of magnetic resonance imaging (MRI) and transesophageal echocardiography (TEE) as "second-line" techniques for unresolved diagnostic problems.

METHODS AND RESULTS

Eighty-five patients were studied; 81 had MRI with a 0.5-T magnet to obtain spin-echo images, cine-MRI, and flow-velocity maps. Seventy-nine patients had TEE (37 biplane). A simple score (range, 0 to 1) was used for quantification of the results of MRI and TEE alone, for their comparison (in the 75 patients who had both), and for assessment of their combination. MRI, TEE, or their combination achieved a score of at least 0.75 in 18 of 25 diagnostic categories. A summary of the scores showed that for intracardiac anatomy. MRI scored 0.34, TEE scored 0.71 (P < .0001), and MRI plus TEE scored 0.84 (P < .003); for extracardiac anatomy, MRI scored 0.76, TEE scored 0.23 (P < .0001), and MRI plus TEE scored 0.84 (P = NS); and for hemodynamics and function, MRI scored 0.58, TEE scored 0.41 (P < .05), and MRI plus TEE scored 0.67 (P = NS). Total scores were MRI, 0.52; TEE, 0.50 (P = NS); and MRI plus TEE, 0.80 (P < .0001). MRI and TEE were inadequate for collateral and coronary arteries and pulmonary vascular resistance. Cine-MRI and flow-velocity maps comprised 43% of the MRI scores. Biplane TEE was better than single plane (scores of 0.59 versus 0.42, P < .0001).

CONCLUSIONS

MRI and TEE are important and complementary "second-line" investigations for congenital heart disease. Analysis of their performance in a wide range of diagnostic categories provides guidelines for their judicious application. Where both are available, diagnostic catheterizations are either obviated or simplified.

Transesophageal echocardiographic recognition of an unusual complication of aortic valve endocarditis

Aortic valve endocarditis can cause complications due to involvement of the subaortic structures. These complications include satellite vegetations on the aortic regurgitant jet lesion sites, involvement of the anterior or posterior mitral valve leaflets in the form of aneurysms, perforation, and involvement of the mitral-aortic intervalvular fibrosa, namely abscess, aneurysm, and perforation into the left atrium or the pericardial sac. These complications can be identified accurately by echocardiography. We report an unusual case which demonstrates (1) coexistence of both mitral-aortic intervalvular fibrosa and mitral valve aneurysms, and (2) echocardiographic follow-up of a mitral valve aneurysm to perforation. These complications were recognized by transesophageal echocardiography and verified at surgery.