Related Experiment Video
Updated: Dec 20, 2025
3D Whole-heart Myocardial Tissue Analysis
Published on: April 12, 2017
Unique characterization of complex endocarditic vegetations using 3D TOE
Muhammad Khan1, Ruben De Sousa2, Kam Rai2
1University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK. Muhammad.Khan@uhcw.nhs.uk.
Abstract:
A 31-year-old male was admitted with suspected infective endocarditis, given a history of i.v. drug use, lung and cerebral abscesses and Staphylococcus aureus bacteraemia. TTE imaging was limited given supine positioning and mechanical ventilation but suggested a posterior mitral valve leaflet (PMVL) mass. Three-dimensional TOE provided uniquely detailed assessment of two complex infective masses. The attachment of the presumed P2 mass on TTE was indeterminant even on 2D-TOE, appearing attached to the PMVL or AMVL depending on rotational view (Fig. 1). 3D-TOE imaging and subsequent multiplanar and volume-rendered reconstruction revealed this to be a complex, large vegetation attached to the anterior aspect of the anterolateral commissure with mobile heads prolapsing into the left atrium and causing mild mitral regurgitation through a small basal perforation (Figs 2, 3 and Video 1). The second mass was a filamentous vegetation attached to the LVOT, prolapsing towards but not contacting the aortic valve (Fig. 4 and Video 2). Comprehensive assessment of complex vegetations is crucial for optimal surgical planning. 3D-TOE allows rapid, accurate, unique assessment of such masses through unlimited multiplanar reconstructions, volume-rendered real-time imaging and colour full-volume regurgitation assessment which may not always possible on 2D-TTE or 2D-TOE. 3D imaging should be routinely used in TOE and in particular in suspected endocarditis.
Insights
Three-dimensional transesophageal echocardiography (3D-TOE) offers superior visualization of complex infective endocarditis vegetations compared to traditional methods. This advanced imaging is crucial for accurate diagnosis and surgical planning in suspected cases.
Area of Science:
- Cardiology
- Medical Imaging
- Infectious Diseases
Background:
- Infective endocarditis (IE) diagnosis can be challenging, especially with limited transthoracic echocardiography (TTE) views.
- Intravenous drug use and Staphylococcus aureus bacteraemia are risk factors for IE.
- Complex vegetations require detailed assessment for effective management.
Purpose of the Study:
- To evaluate the utility of three-dimensional transesophageal echocardiography (3D-TOE) in assessing complex infective endocarditis vegetations.
- To compare the diagnostic capabilities of 3D-TOE with conventional 2D imaging modalities.
Main Methods:
- Case study of a patient with suspected IE and Staphylococcus aureus bacteraemia.
- Utilized 2D and 3D transesophageal echocardiography (TOE) for imaging.
- Performed multiplanar and volume-rendered reconstructions for detailed analysis.
Main Results:
- 3D-TOE provided detailed visualization of two complex vegetations, including a large mitral valve vegetation and a filamentous vegetation in the left ventricular outflow tract (LVOT).
- Accurately identified vegetation attachment, prolapse, and associated mitral regurgitation and LVOT involvement.
- Demonstrated limitations of 2D-TTE and 2D-TOE in characterizing vegetation complexity and precise location.
Conclusions:
- 3D-TOE offers rapid, accurate, and unique assessment of complex vegetations in infective endocarditis.
- Comprehensive assessment via 3D imaging is crucial for optimal surgical planning.
- Routine use of 3D imaging in TOE is recommended for suspected endocarditis cases.
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