1
|
Nagiub M, Fares M, Ganigara M, Ullah S, Hsieh N, Jaquiss R, Dillenbeck J, Hussain T. Value of Time-Resolved Cardiac CT in Children and Young Adults with Congenital Heart Disease and Infective Endocarditis. Pediatr Cardiol 2022:10.1007/s00246-022-03069-7. [PMID: 36534136 DOI: 10.1007/s00246-022-03069-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/03/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Diagnosis of infective endocarditis (IE) can be challenging due to negative blood cultures and diagnostic limitations of various imaging modalities. Transesophageal echocardiography (TEE) is the gold standard imaging modality for visualization of valvular vegetations. However, due to the anterior location of the pulmonary valve, post-surgical changes, and sedation requirement, TEE can be challenging in the pediatric population. The aim of this study was to assess the value of Cardiac CT (CCT) for diagnosis of IE in children and young adults with congenital heart disease (CHD). METHODS This is a single-center retrospective study of pediatric patients with CHD and diagnosis of IE who underwent CCT from 2018 to 2022. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic/CCT findings, and blood culture results. In addition, modified Duke criteria (MDC) for the diagnosis of IE were applied with and without CCT findings as the diagnostic imaging criterion. RESULTS Fourteen patients were included in this study with a median age of 11 years old. Nine patients were female. Ten patients had IE of the RV-PA conduit and four patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. After including CCT findings, 11 patients (79%) met MDC for definite IE. Blood cultures were positive in 12 patients. CCT revealed the following complications: thromboembolic findings/pseudoaneurysms in 5 patients each and prosthetic valve perforation/prosthetic valve leak in one patient each. CONCLUSIONS This study reinforces the complimentary role of CCT to echocardiography in the work-up and diagnosis of IE in patients with CHD. With further improvement in lowering radiation exposure, CCT may have a key role in the diagnostic work-up of endocarditis and could be implemented in the diagnostic criteria of IE.
Collapse
Affiliation(s)
| | - Munes Fares
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | - Sana Ullah
- UT Southwestern Medical Center, Dallas, TX, USA
| | | | | | | | | |
Collapse
|
2
|
Miyawaki N, Okada T, Koyama T, Furukawa Y. Right-sided Infective Endocarditis with Ventricular Free Wall Vegetation Caused by Abiotrophia defectiva in a Patient with Unrepaired Ventricular Septal Defect. Intern Med 2022; 61:3373-3376. [PMID: 35431307 PMCID: PMC9751724 DOI: 10.2169/internalmedicine.9374-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To our knowledge, there have been no reports of right-sided infective endocarditis (RSIE) with ventricular free wall vegetation caused by Abiotrophia defectiva. We herein report a case of RSIE caused by A. defectiva with ventricular free wall vegetation in a 27-year-old man with ventricular septal defect (VSD). Computed tomography showed multiple bilateral pulmonary nodular shadows. Transesophageal echocardiography (TEE) demonstrated right ventricular free wall vegetation at the jet stream. Blood culture revealed A. defectiva. These findings are consistent with a diagnosis of infective endocarditis and septic pulmonary embolism. Treatment with ceftriaxone and gentamicin and subsequent surgical VSD closure improved the patient's condition without recurrence.
Collapse
Affiliation(s)
- Norihisa Miyawaki
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan
| | - Taiji Okada
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan
| | - Tadaaki Koyama
- Department of Cardiothoracic Surgery, Kobe City Medical Center General Hospital, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Japan
| |
Collapse
|
3
|
Right ventricular outflow tract endocarditis caused by brucellosis. J Infect Public Health 2017; 10:678-680. [DOI: 10.1016/j.jiph.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/23/2016] [Accepted: 09/10/2016] [Indexed: 11/22/2022] Open
|
4
|
Xie J, Liu S, Yang J, Xu J, Zhu G. Inaccuracy of transthoracic echocardiography for the identification of right‐sided vegetation in patients with no history of intravenous drug abuse or cardiac device insertion. J Int Med Res 2014; 42:837-48. [PMID: 24717408 DOI: 10.1177/0300060513505498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/28/2013] [Indexed: 11/16/2022] Open
Abstract
Objective: The use of transthoracic echocardiography (TTE) to identify right-sided infective endocarditis (RSIE) vegetation is controversial. Data are scarce for patients with no history of intravenous drug abuse (IVDA) or cardiac device insertion. This study analysed the consistency of presurgical echocardiographic results with surgical findings for vegetation identification, and the factors that influence accuracy of echocardiography. Methods: This retrospective trial divided infective endocarditis (IE) patients into three subgroups according to the results of their presurgical TTE: left-sided native IE (LSNIE), left-sided prosthetic valve IE (LSPIE) and RSIE. The accuracy of TTE was tested by comparing vegetation (number and location), detected presurgery by TTE, with actual findings during surgery. Results: In total, 416 patients were analysed, 322 with LSNIE, 31 with LSPIE and 63 with RSIE. Consistency between TTE findings and surgical results was lower in the RSIE group compared with the LSPIE and LSNIE groups. Consistency was lowered by the presence of vegetation in multiple locations and atypical distribution – both of which were increased in the RSIE group. The chance of vegetation in both sides of the heart rose with increased numbers of vegetation locations in RSIE patients. A high proportion of RSIE patients had congenital heart defects, mostly ventricular septal defects. Conclusions: TTE may be unsuitable for RSIE patients with no history of IVDA or cardiac device insertion, because multifocal and atypically distributed vegetation may influence detection accuracy.
Collapse
Affiliation(s)
- Jiang Xie
- Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Liu
- Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinghua Yang
- Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Xu
- Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guangfa Zhu
- Pulmonary Heart Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
Akinosoglou K, Apostolakis E, Marangos M, Pasvol G. Native valve right sided infective endocarditis. Eur J Intern Med 2013; 24:510-9. [PMID: 23369408 DOI: 10.1016/j.ejim.2013.01.010] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/23/2012] [Accepted: 01/04/2013] [Indexed: 11/25/2022]
Abstract
Right-sided infective endocarditis (RSIE) accounts for 5-10% of all cases of infective endocarditis (IE), and is predominantly encountered in the injecting drug user (IDU) population, where HIV and HCV coinfections often coexist. Staphylococcus aureus is the most common pathogen. The pathogenesis of RSIE is still not well understood. RSIE usually presents as a persistent fever with respiratory symptoms whilst signs of systemic embolisation as seen in left-sided IE are notably absent. The prompt diagnosis of RSIE thus requires a high index of suspicion. Transthoracic echocardiography (TTE) can detect the majority of RSIE, whilst transoesophageal echocardiography (TOE) can increase sensitivity. Virulence of the causative organism and vegetation size are the major determinants of prognosis. Most cases of RSIE resolve with appropriate antibiotic administration.
Collapse
Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Patras, 26504, Rio, Greece.
| | | | | | | |
Collapse
|
6
|
Abstract
Infectious endocarditis remains both a diagnostic and a treatment challenge. A positive outcome depends on a rapid diagnosis, accurate risk stratification, and a thorough follow-up. Imaging plays a key role in each of these steps and echocardiography remains the cornerstone of the methods in use. The technique of both transthoracic echocardiography and transoesophageal echocardiography has been markedly improved across the last decades and most recently three-dimensional real-time echocardiography has been introduced in the management of endocarditis patients. Echocardiography depicts structural changes and abnormalities in the heart, but it does not uncover the underlying pathophysiological processes at the cellular or molecular level. This problem is addressed with introduction of new molecular imaging methods as (18)F-fluorodesoxyglucose ((18)F-FDG) PET-CT and single photon emission computed tomography fused with conventional CT (SPECT/CT). Of these methods, (18)F-FDG PET-CT carries the best promise for a future role in endocarditis. But there are distinct limitations with both SPECT/CT and (18)F-FDG PET-CT which should not be neglected. MRI and spiral CT are methods primarily used in the search for extra cardial infectious foci. A flowchart for the use of imaging in both left-sided and right-sided endocarditis is suggested.
Collapse
Affiliation(s)
- Niels Eske Bruun
- Department of Cardiology, Gentofte University Hospital, Niels Andersens Vej 65, Hellerup 2900, Denmark
| | | | | | | |
Collapse
|
7
|
Sedgwick JF, Burstow DJ. Update on echocardiography in the management of infective endocarditis. Curr Infect Dis Rep 2012; 14:373-80. [PMID: 22544484 DOI: 10.1007/s11908-012-0262-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Echocardiography is the major imaging modality used for the diagnosis of infective endocarditis (IE). It is also useful in detecting the complications of IE which often necessitate surgical intervention and strongly influence patient outcomes. Transesophageal echocardiography (TEE), with proven superiority over transthoracic echocardiography (TTE) for the detection of vegetations and complications such as abscess, should be performed in the vast majority of cases especially when TTE image quality is poor or implanted devices are present. Three-dimensional (3D) TEE provides enhanced display of anatomic-spatial relationships allowing more precise delineation of complex pathology, particularly of the mitral valve and annulus. Importantly, echocardiographic findings can be non-specific and should always be interpreted in the context of the pre-test probability of IE based on careful clinical assessment. IE remains a challenging disease associated with variable clinical presentations, and high mortality. Whenever IE is suspected, echocardiography should be utilized early for both diagnosis and detection of complications.
Collapse
|
8
|
Role of transthoracic and transesophageal echocardiography in right-sided endocarditis: one echocardiographic modality does not fit all. J Am Soc Echocardiogr 2012; 25:807-14. [PMID: 22727494 DOI: 10.1016/j.echo.2012.05.016] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Indexed: 12/12/2022]
Abstract
The added value of transesophageal echocardiography (TEE) over transthoracic echocardiography in the assessment of left-sided infective endocarditis has been extensively validated in the literature. Little research has dealt with the role of echocardiography in right-sided infective endocarditis (RSE), however. In this review, the differences between RSE and left-sided endocarditis and the different types of RSE according to the types of patients who have the disease are described. Both issues have important implications for echocardiographic workup. Moreover, a systematic echocardiographic protocol to avoid missing right-sided vegetations and several specific morphologic aspects of RSE are reviewed. Normal right-sided structures, which may mimic vegetations, particularly when the clinical picture is compatible, are described. Finally, the value of transthoracic echocardiography and TEE in RSE is reviewed according to the publications available. The diagnostic yield of transthoracic echocardiography is comparable with that of TEE in intravenous drug users. On the contrary, TEE is mandatory in patients with cardiac devices. A Bayesian-based diagnostic approach is proposed for a third poorly characterized group of patients with RSE who are not drug addicts, have no cardiac devices, and have no left-sided endocarditis (the "three no's" endocarditis group).
Collapse
|
9
|
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Luis Zamorano J. Guía de práctica clínica para prevención, diagnóstico y tratamiento de la endocarditis infecciosa (nueva versión 2009). Rev Esp Cardiol 2009. [DOI: 10.1016/s0300-8932(09)73131-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
10
|
Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, Moreillon P, de Jesus Antunes M, Thilen U, Lekakis J, Lengyel M, Müller L, Naber CK, Nihoyannopoulos P, Moritz A, Zamorano JL, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, McGregor K, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Vahanian A, Aguilar R, Bongiorni MG, Borger M, Butchart E, Danchin N, Delahaye F, Erbel R, Franzen D, Gould K, Hall R, Hassager C, Kjeldsen K, McManus R, Miro JM, Mokracek A, Rosenhek R, San Roman Calvar JA, Seferovic P, Selton-Suty C, Uva MS, Trinchero R, van Camp G. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369-413. [PMID: 19713420 DOI: 10.1093/eurheartj/ehp285] [Citation(s) in RCA: 1227] [Impact Index Per Article: 81.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Gilbert Habib
- Service de Cardiologie, CHU La Timone, Bd Jean Moulin, 13005 Marseille, France.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Palakodeti V, Keen WD, Rickman LS, Blanchard DG. Eustachian valve endocarditis: detection with multiplane transesophageal echocardiography. Clin Cardiol 2009; 20:579-80. [PMID: 9181271 PMCID: PMC6656125 DOI: 10.1002/clc.4960200613] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Right-sided involvement is fairly common in infective endocarditis, but involvement of the eustachian valve is distinctly rare. We present the case of a 36-year-old intravenous drug user with staphylococcal bacteremia and septic pulmonary emboli. Transthoracic echocardiography was normal, but transesophageal echocardiography revealed a large eustachian valve vegetation. This case illustrates the utility of multiplane transesophageal echocardiography in the evaluation of eustachian valve pathology.
Collapse
Affiliation(s)
- V Palakodeti
- University of California, San Diego School of Medicine, USA
| | | | | | | |
Collapse
|
12
|
Affiliation(s)
- Gaetano Nucifora
- Cardiopulmonary Science Department, Azienda Ospedaliero-Universitaria di Udine, P. le S. Maria della Misericordia 15, 33100 Udine, Italy.
| | | | | | | | | | | |
Collapse
|
13
|
Cosson S, Kevorkian JP, Milliez P, Beaufils P, Cohen A. A rare localization in right-sided endocarditis diagnosed by echocardiography: a case report. Cardiovasc Ultrasound 2003; 1:10. [PMID: 12952545 PMCID: PMC194433 DOI: 10.1186/1476-7120-1-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Accepted: 08/14/2003] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Right-sided endocarditis occurs predominantly in intravenous drug users, patients with pacemakers or central venous lines and with congenital heart diseases. The vast majority of cases involve the tricuspid valve. CASE PRESENTATION A case of a 31-year-old woman with intravenous drug abuse who had a right-sided vegetation attached to the muscular bundle of the right ventricle is presented. Transthoracic echocardiography revealed a vegetation in the right ventricular outflow tract. Transesophageal echocardiography clearly showed that the 1.8 cm vegetation was not adherent to the pulmonary valve but attached to a muscular bundle. CONCLUSIONS Our case points to an unusual location of right-sided endocarditis in intravenous drug users. It confirms that TTE remains an easy and highly sensitive first-line examination for the diagnosis of right-sided endocarditis.
Collapse
Affiliation(s)
- Stéphane Cosson
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Jean-Philippe Kevorkian
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Paul Milliez
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Philippe Beaufils
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| | - Ariel Cohen
- Service de cardiologie, Hôpital Lariboisière, Paris and Service de cardiologie, Hôpital Saint-Antoine, Paris, France
| |
Collapse
|
14
|
|
15
|
Affiliation(s)
- R P Scott
- Department of Surgery, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA.
| |
Collapse
|
16
|
Bartel T, Müller S, Nesser HJ, Möhlenkamp S, Bruch C, Erbel R. Usefulness of motion patterns indentified by tissue Doppler echocardiography for diagnosing various cardiac masses, particularly valvular vegetations. Am J Cardiol 1999; 84:1428-33. [PMID: 10606117 DOI: 10.1016/s0002-9149(99)00590-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study sought to test whether anomalous cardiac and aortic structures can be differentiated from native tissue and artifacts by physical properties of tissue motion using transesophageal tissue Doppler echocardiography (TDE). TDE was employed in 85 consecutive patients after anomalous structures had been detected by conventional transesophageal echocardiography (TEE). The control group consisted of 40 randomized patients. Certainty of diagnosis was divided into 4 categories, and TDE signals were related to particular anomalous structures by a blinded second observer. A mechanical model of a beating ventricle was constructed and suspended in a water bath. Synthetic material was utilized to simulate anomalous intracavitary structures with varying shape, consistency, and attachment. Incoherent motion was present in endocarditic vegetations, freely oscillating thrombi, fourth-degree aortic plaques, Chiari network, valvular prolapse, tumors, and in normal valve leaflets and papillary muscles. Within 15 seconds vegetations could be detected in 17 patients (68%) using TDE versus 5 patients (20%) using only conventional imaging. Coherent motion with a phase difference occurred due to damped oscillation. This phenomenon occurred in 5 patients with thrombi of the left atrial appendage (100%), in 3 ventricular clots (75%), and in 2 hypernephroma in the right atrium (100%). Rapid identification of clots could be achieved in 15 patients (71%) versus 12 patients (57%). Concordant motion was shown in third-degree aortic plaques, postrheumatic valvular lesions, and aortic intramural hematomas, but diagnostic benefit could not be demonstrated. In 41 patients (48%) histopathologic and intraoperative results confirmed echocardiographic findings. Motion patterns could be reproduced independently of the heart rate by model experiments. This study demonstrates that TDE expedites the detection of vegetations in infective endocarditis. Diagnostic certainty can be increased as well for thrombus formations.
Collapse
Affiliation(s)
- T Bartel
- Department of Cardiology, University Essen, Germany
| | | | | | | | | | | |
Collapse
|
17
|
Schwartzbard AZ, Tunick PA, Rosenzweig BP, Kronzon I. The role of transesophageal echocardiography in the diagnosis and treatment of right atrial thrombi. J Am Soc Echocardiogr 1999; 12:64-9. [PMID: 9882780 DOI: 10.1016/s0894-7317(99)70174-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty patients with right atrial thrombi were identified through the use of transthoracic and transesophageal echocardiography. Transesophageal echocardiography identified right atrial thrombi in all 20 cases. Transthoracic echocardiography showed definite thrombi in only 6 (30%) cases and suggested thrombus in another 2 (10%) patients. Thus transthoracic echocardiography results were false-negative for right atrial thrombus in 60% of cases. All 3 thrombi found within the right atrial appendage and 2 of 3 thrombi on pacemaker wires were missed by transthoracic echocardiography. There was no significant difference in the mean size between those thrombi seen (1.37 +/- 0.6 cm) and those missed (1.5 +/- 0.9 cm) by transthoracic echocardiography. Transesophageal echocardiography also significantly affected treatment. Anticoagulation was initiated or amplified in 13 patients. In 8 of these 13, thrombi were seen only by transesophageal echocardiography. Surgery was performed to remove thrombi in 7 cases, and in 3 (43%) cases it was because of thrombi seen only by transesophageal echocardiography. This study suggests that transesophageal echocardiography should be performed whenever right atrial thrombi are suspected. Transesophageal echocardiography has a significant effect on the diagnosis and management of patients with right atrial thrombi.
Collapse
Affiliation(s)
- A Z Schwartzbard
- Charles and Rose Wohlstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, New York, NY 10016, USA
| | | | | | | |
Collapse
|
18
|
Complicações pulmonares de endocardite tricúspide num doente toxicómano. REVISTA PORTUGUESA DE PNEUMOLOGIA 1997. [DOI: 10.1016/s0873-2159(15)31084-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
19
|
Fehske W, Jung W, Omran H, Manz M, Moosdorf R, Lüderitz B. Multiplane transesophageal echocardiographic evaluation of transvenous defibrillation leads. JOURNAL OF CLINICAL ULTRASOUND : JCU 1995; 23:153-162. [PMID: 7730460 DOI: 10.1002/jcu.1870230302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Permanent transvenous cardioverter-defibrillator leads were investigated by multiplane transesophageal echocardiography (TEE) (1) to determine whether intracardiac lead segments can be visualized, (2) to verify the position of the coils, and (3) to detect possible thrombus formation. The diagnostic information obtained in 62 patients by TEE was compared to that of transthoracic echocardiography (TTE). Abnormal findings were only visualized by multiplane TEE. However, further controlled studies are needed to determine the clinical relevance of displaced caval (one patient) and ventricular coils (15 patients), ventricular (1 patient) or atrial (6 patients) loops, and of clinically uneventful thrombi (13 patients).
Collapse
Affiliation(s)
- W Fehske
- Department of Cardiology, University of Bonn, Germany
| | | | | | | | | | | |
Collapse
|
20
|
Yvorchuk KJ, Chan KL. Application of transthoracic and transesophageal echocardiography in the diagnosis and management of infective endocarditis. J Am Soc Echocardiogr 1994; 7:294-308. [PMID: 8060646 DOI: 10.1016/s0894-7317(14)80400-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Infective endocarditis continues to be a cause of significant cardiac morbidity and mortality. To improve the prognosis of patients with this disorder, early diagnosis is crucial but difficult to establish on the basis of clinical parameters alone. Echocardiography, both transthoracic and transesophageal techniques, has a major role in the detection of vegetations that are the hallmark of endocarditis. Valvular and perivalvular complications can also be well assessed by echocardiography. With the improved resolution provided by recent technologic advances in echocardiography, vegetations can be reliably detected in most patients with endocarditis. We propose that present diagnostic criteria for endocarditis be revised to include echocardiographic findings as a major parameter in the diagnosis. Finally, a diagnostic approach incorporating transthoracic and transesophageal echocardiography in these patients will be discussed taking into consideration the different degrees of clinical suspicion for the existence of the disease.
Collapse
Affiliation(s)
- K J Yvorchuk
- University of Ottawa Heart Institute, Ontario, Canada
| | | |
Collapse
|
21
|
|
22
|
Sharma S, Pinto RJ, Gangakhedkar DP, Goyal R, Shah NA. Superiority of transoesophageal echocardiography in detection of multichambered multiple myxoma. Int J Cardiol 1993; 42:292-4. [PMID: 8138340 DOI: 10.1016/0167-5273(93)90063-m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We describe a rare case of a sporadiac form of multiple myxoma and highlight the unusual combination of left atrial and right ventricular tumors. Transoesophageal echocardiography proved superior to precordial imaging in detecting all four masses (two in left atrium and two in right ventricle).
Collapse
|