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Transesophageal Echocardiography-Guided Percutaneous Aspiration of a Large Tricuspid Valve Vegetation in a Patient with Infective Endocarditis.

ABSTRACT:

SUBMITTER: Stoker A

PROVIDER: S-EPMC9510623 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Transesophageal Echocardiography-Guided Percutaneous Aspiration of a Large Tricuspid Valve Vegetation in a Patient with Infective Endocarditis.

Stoker Alexander A Gosling Andre A Williams Adam A Overbey Douglas D Nicoara Alina A Pollak Angela A

CASE (Philadelphia, Pa.) 20220523 7

PMID: 36172475

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Percutaneous Aspiration of Vegetation in Tricuspid Valve Infective Endocarditis : A Possible Novel Treatment Option

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Diagnostic value of harmonic transthoracic echocardiography in native valve infective endocarditis: comparison with transesophageal echocardiography.

Project description:BackgroundAlthough echocardiography has been incorporated into the diagnostic algorithm of patients with suspected infective endocarditis (IE), systematic usage in clinical practice remains ill defined. To determine the diagnostic accuracy of detecting vegetations using harmonic transthoracic echocardiography (hTTE) as compared to transesophageal echocardiography (TEE) in patients with an intermediate likelihood of native valve IE.MethodsBetween 2004 and 2005, 36 consecutive inpatients with an intermediate likelihood of disease were prospectively evaluated by hTTE and TEE.ResultsOf 36 patients (21 males with a mean age of 57 +/- 15 years, range 32 to 86 years), 19 patients had definite IE by TEE. The sensitivity for the detection of vegetations by hTTE was 84%, specificity of 88%, positive predictive value (PPV) of 89% and negative predictive value (NPV) of 82%. The association between hTTE and TTE interpretation for the presence and absence of vegetations were high (kappa = 0.90 and 0.85 respectively).ConclusionIn patients with an intermediate likelihood of native valve IE, TTE with harmonic imaging provides diagnostic quality images in the majority of cases, has excellent concordance with TEE and should be recommended as the first line test.

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Transesophageal Echocardiography Diagnosis of Tricuspid Valve Injury During AngioVac Percutaneous Pulmonary Embolectomy.

Project description:Highlights•Imaging evidence of right ventricular dysfunction predicts risk in pulmonary embolism.•Catheter techniques are an alternative to systemic lysis or surgical embolectomy.•Catheter embolectomy may be enhanced by transesophageal echocardiographic imaging.

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A case of percutaneous tricuspid valve infective endocarditis vegetation debulking using the AngioJet rheolytic catheter system-A novel therapeutic use.

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Project description:Intravenous drug use has increased substantially over the past decade, with heroin abuse more than doubling. Injection drug use-related infective endocarditis hospitalizations have similarly increased over the same period. Right-sided infective endocarditis is strongly associated with intravenous drug use, and 90% of right-sided endocarditis involves the tricuspid valve. During the period of the opioid epidemic, tricuspid-related endocarditis rates have increased, while the incidence of surgery for tricuspid endocarditis has increased as much as five-fold. Within this context, optimizing surgical technique for valve repair is increasingly important. In this report, we examine the indications for tricuspid valve surgery for endocarditis, describe specific techniques for tricuspid valve leaflet repair and augmentation, and assess postoperative care and surgical outcomes after both tricuspid valve repair and replacement for infective endocarditis.

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Diagnostic performance of contemporary transesophageal echocardiography with modern imaging for infective endocarditis.

Project description:BackgroundInfective endocarditis (IE) is associated with high morbidity and mortality. Following an initial negative transesophageal echocardiogram (TEE), high clinical suspicion warrants repeat examination. We evaluated the diagnostic performance of contemporary TEE imaging for IE.MethodsThis retrospective cohort study included patients ≥18 years old undergoing ≥2 TEEs within 6 months, with confirmed diagnosis of IE based on Duke criteria, 70 in 2011 and 172 in 2019, were included. We compared the diagnostic performance of TEE for IE in 2019 versus 2011. The primary endpoint was the sensitivity of initial TEE to detect IE.ResultsSensitivity of the initial TEE to detect endocarditis was 85.7% versus 95.3%, in 2011 and 2019, respectively (P=0.01). On multivariable analysis, initial TEE more frequently detected IE in 2019, compared to 2011 [odds ratio (OR): 4.06, 95% confidence intervals (CIs): 1.41-11.71, P=0.01]. Improved diagnostic performance was driven by improved detection of prosthetic valve infective endocarditis (PVIE), sensitivity 70.8% in 2011 versus 93.7% (P=0.009) in 2019. In 2019, TEEs more frequently utilized probes with higher frame rates/resolution, than 2011 (P<0.001). Three dimensional (3D) technology was utilized in 97.2% of initial TEEs in 2019, compared to 70.5% in 2011 (P<0.001).ConclusionsContemporary TEE was associated with improved diagnostic performance for endocarditis, driven by improved sensitivity for PVIE.

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Unmasking Severe Tricuspid Valve Regurgitation After Percutaneous Debulking of Large Tricuspid Vegetation.

Project description:A 27-year-old man admitted with tricuspid valve endocarditis with a large vegetation, persistent bacteremia, and pulmonary and systemic septic embolization was deemed not a suitable surgical candidate. He underwent percutaneous vegetation debulking using the AngioVac system. The patient defervesced post-operatively with clinical improvement but with abruptly worsened tricuspid regurgitation. (Level of Difficulty: Beginner.).

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