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Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging?

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Abstract

The role of two dimensional (2D) echocardiography (ECHO) for the diagnosis and clinical decision making in infective endocarditis (IE) has been extensively studied and described in the medical literature. Some reports have demonstrated the incremental value of three dimensional (3D) transesophageal (TE) ECHO in the setting of IE. However, a systematic review focusing on the role of 3D imaging is lacking. In this manuscript, we examine the role of 3D TE ECHO in the diagnosis of IE. IE is a challenging disease in which 2D transthoracic (TT) and TE ECHO have complementary roles and are unequivocally the mainstay of diagnostic imaging. Still, 2D imaging has important limitations. Technological advances in 3D imaging allow for the reconstruction of real-time anatomical images of cardiac structure and function. 3D imaging has emerged as a diagnostic technique that overcame some of the limitations of 2D ECHO. Currently, both transthoracic and transesophageal echocardiography transducers are able to generate 3D images. However, 3D TE ECHO provides images of a higher quality in comparison to 3D TT ECHO, and is the best echocardiographic modality able to allow for a detailed anatomical imaging. 3D TE ECHO may represent the key adjunctive echocardiographic technique being able to positively impact on IE-related surgical planning and intervention and to facilitate the interaction between the surgeon and the imaging specialist. Importantly, 3D TE ECHO is not the recommended initial modality of choice for the diagnosis of IE; however, in highly specialized centers, it has become an important complementary technique when advanced surgical planning is required. Furthermore, anatomical imaging has become the link between the different techniques that play a role in IE imaging. In fact, both computed tomography and magnetic resonance allow three dimensional reconstruction. An important future goal should allow for the fusion among various imaging modalities. Our review highlights the role of 3D TE ECHO in IE imaging and emphasize where it offers incremental value.

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Acknowledgements

We would like to thank Abdul Rahim, RCS, for performing the transthoracic studies and in analysing and reviewing the images and results.

Funding

No Funding has been received by any of the authors.

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Authors and Affiliations

  1. The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

    Domenico Galzerano, Olga Vriz, Bahaa M. Fadel & Hani Al Sergani

  2. College of Medicine, Alfaisal University, Riyadh, Saudi Arabia

    Domenico Galzerano & Bahaa M. Fadel

  3. Ministry of National Guard Health Affair, COM-WR, King Abdullah International Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

    Abdulhalim J. Kinsara

  4. Divisione di Cardiologia, Ospedale San Filippo Neri, Rome, Italy

    Sara Di Michele

  5. Ecocardiografia Basale e Complessa, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy

    Rita Leonarda Musci & Paolo Colonna

  6. Department of Cardiology, Cardiac Surgery and Cardiovascular Emergencies, Federico II, University of Naples, Naples, Italy

    Maurizio Galderisi

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  1. Domenico Galzerano
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Correspondence to Domenico Galzerano.

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Galzerano, D., Kinsara, A.J., Di Michele, S. et al. Three dimensional transesophageal echocardiography: a missing link in infective endocarditis imaging?. Int J Cardiovasc Imaging 36, 403–413 (2020). https://doi.org/10.1007/s10554-019-01747-x

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