Real time three-dimensional echocardiography and endovascular stenting

Area of Science:

• Cardiology
• Infectious Diseases
• Medical Imaging

Background:

• A 52-year-old male with HIV and chronic renal failure presented with fever and chills.
• He had undergone recent superior vena cava (SVC) stent placement for SVC stenosis due to multiple dialysis-catheter insertions.
• Blood cultures identified methicillin-resistant Staphylococcus aureus (MRSA).

Observation:

• Initial two-dimensional (2D) echocardiography revealed no vegetations.
• A subsequent 2D transesophageal echocardiogram (TEE) confirmed stent patency at the SVC-right atrial junction but did not visualize the entire stent.
• High clinical suspicion for complications persisted despite initial negative findings.

Findings:

• Three-dimensional TEE provided superior cross-sectional and longitudinal imaging of the SVC stent.
• 3D TEE clearly demonstrated a patent stent without vegetations, stenosis, migration, or thrombosis.
• This confirmed the absence of endocarditis and stent-related complications.

Implications:

• 3D TEE offers enhanced visualization of complex intracardiac and intravascular devices like SVC stents.
• This advanced imaging modality can be crucial in diagnosing or excluding complications in high-risk patients.
• Accurate stent assessment is vital for managing patients with MRSA bacteremia and indwelling devices.