Native and Prosthetic Valve Endocarditis: Incremental Value of 3DE over 2DE

Abstract

Echocardiography is critical to the diagnosis of endocarditis, identifying its sequelae, assessment of hemodynamic complications, and guiding management. However, two dimensional echocardiography (2DE) provides tomographic slices with often the need for off-axis imaging to detect pathology. In contrast, three-dimensional echocardiography (3DE) can image an entire region of interest from a single acoustic window, thus alleviating the need for “mental reconstruction” of the 2D images, and multiplanar reconstruction of the 3D volumetric data set allows visualization of cardiac involvement by endocarditis from virtually any desired perspective. Importantly, because images on 3DE reflect true anatomy and pathology, they are readily recognizable by cardiac surgeons, non-imaging cardiologists, and pathologists. 3DE thus complements 2DE by providing a more comprehensive pathoanatomical characterization of endocarditis associated lesions. 3D TEE is superior to 2D TEE for the diagnosis and assessment of many complications of endocarditis such as valve perforations and prosthetic valve dehiscence, and for characterizing complex lesions such as abscesses that typically are not limited to specific tissue planes, and can extend in directions beyond the tomographic planes that are routinely acquired on 2D TEE. Accurate delineation of the extent of cardiac involvement by endocarditis also enables better risk stratification of infected patients that can translate to better timing and planning of surgical intervention.