Tricuspid valve endocarditis: Cardiovascular imaging evaluation and management

Figure 1 Transthoracic echocardiography and computed tomography imaging assessment of native tricuspid valve endocarditis. A: Modified apical four-chambers view, focused on the tricuspid valve showing a vegetation attached on tricuspid valve (arrow); B: Color Doppler analysis showing severe tricuspid regurgitation caused by the vegetation; C: Sub-xiphoid view, measuring the vegetation as 1.6 cm; D: Short-axis view, showing the vegetation on the tricuspid valve prolapsing into the right atrium (arrow); E and F: Computed tomography lung demonstrating multiple areas of septic cavitations. RA: Right atrium; RV: Right ventricle; LA: Left atrium; LV: Left ventricle.

Figure 2 Transesophageal echocardiography of prosthetic tricuspid valve endocarditis. A: 3D view showing a prosthetic tricuspid valve with an attached mobile vegetation (arrow); B: 2D multi-plane view showing (arrow) a bulky lesion prolapsing across the tricuspid prosthesis (asterisk); C: Color Doppler interrogation confirms significant prosthetic tricuspid stenosis (transvalvular gradients: 37/21 mmHg at 98 beats per minute). RA: Right atrium; RV: Right ventricle.

Figure 3 Transesophageal echocardiography in native tricuspid valve endocarditis. A: Mid-esophageal modified short-axis view showing a large vegetation attached to the native tricuspid valve (arrow); B: 3D transesophageal echocardiography imaging showing the vegetation to arise from posterior tricuspid leaflet; C: 3D multi-planar reconstruction on the vegetation, confirming the location on the posterior leaflet (arrow); D: Transgatric view, showing multi-planar assessment of the vegetation. RA: Right atrium; RV: Right ventricle; LA: Left atrium; LV: Left ventricle; TV: Tricuspid valve.

Figure 4 Multislice computed tomography with contrast. Status post tricuspid valve repair. Lobulated pocket of free flowing blood/contrast interposed between the tricuspid annulus and the aortic annulus compatible with an abscess/fistula (arrow). Asterisk showing the tricuspid valve repair.