A CASE OF A HUGE AORTIC PSEUDO–ANEURYSM FOLLOWING AORTIC BIO PROSTHETIC ENDOCARDITIS: KEY ROLE OF 3D ECHOCARDIOGRAPHY

Complications of infective endocarditis (IE) are associated with increased mortality and morbidity and therefore guidelines recommend early surgery [. Although two–dimensional echocardiography (2D) is the first line investigation, three–dimensional (3D) imaging provides incremental diagnostic information by allowing visualisation of structures in multiple planes. We present a cases which demonstrate how 3D imaging provides better morphological assessment of valve leaflets and associated structures, allows greater accuracy in identifying complications of IE. A 47 year old male with previous meccanic prosthetic aortic valve replacement was admitted to our department for evaluation of pyrexia. Lab–work was notable for leukocytosis with a white blood cell count of 13.000/mm3 and a hemoglobin level of 10.8 gr/dl. Blood cultures grew Staphylococcus Epidermidis. A transesophageal echocardiogram was performed showing a pulsatile perivalvular echo free–space with colour Doppler flow inside suggestive of an aortic pseudoaneurysm . 3D–TEE imaging provides better morphological assessment of aortic pseudoaneurysm. 3D TEE clearly demarcates an irregularly shaped of perivalvular cavity and through multiplanar reconstruction allowed a correct evaluation of the area and circumference. Conclusione: Decision making in IE is complex. The most common indications for early surgery are development of heart failure, uncontrolled infection or risk of embolism. In particular uncontrolled infection is commonly due to perivalvular abscess formation. 3D–TOE allows rapid, accurate, unique assessment of IE complication 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. This case demonstrate how traditional 2D TEE may provide incomplete anatomical information. 3D imaging improved identification and characterisation of the complications of IE. The complementary data provided aids in decision making with regard to both requirements for timing and planning of surgery.