Tricuspid valve endocarditis: Cardiovascular imaging evaluation and management

Table 1 Strengths and weakness of multimodality imaging techniques in evaluating tricuspid valve infective endocarditis

Imaging modality	Strengths	Weaknesses
Transthoracic echocardiography	Good assessment of vegetation and valvular function; Reproducible and low cost; Evaluation of the hemodynamic consequences	Limited sensitivity for vegetations attached to pacemaker leads and paravalvular complications; Limited ability to evaluate PVE
Transesophageal echocardiography	Better evaluation in PVE and CIED; Tricuspid valve function and PHT assessment; Detection of potential residual material after device extraction	Potential procedural complications for TEE; Limited differentiation between lead vegetation vs thrombus; Limited detection of peripheral complications
Multislice computed tomography	Can detect abscess/pseudoaneurysms; PVE extension and fistulas; Coronary artery preoperative assessment; Identifying pulmonary diseases as abscesses; Evidence of extracardiac involvement	Radiation exposure; Lead artifacts; Limited assessment in small vegetations contrast-induced nephrotoxicity
Magnetic resonance	Detection of extra-cardiac embolic lesions and systemic emboli	Claustrophobia; Cannot be performed for certain CIED
18F-FDG PET/CT	High sensitivity in PVE, generator/pocket and extracardiac or extravascular lead infection; Hypermetabolism + anatomic lesions (vegetations, leaflet thickening and perforation, fistulas); Better definition of the locoregional extension of the infection	Radiation exposure; Patient preparation (myocardial suppression); Visual interpretation. Non-standardized quantification analysis; False positive studies from inflammation or FDG uptake of the prosthetic materials
WBC-SPECT/CT	High specificity for pocket/generator or extravascular lead infection	Radiation exposure; Longer acquisition time; Lower spatial resolution

PVE: Prosthetic valve infection; CIED: Cardiac implantable electronic device; PHT: Pulmonary hypertension; TEE: Limited detection of peripheral complications; 18F-FDG PET/CT: 18F-fluorodeoxyglucose positron emission tomography/computed tomography; WBC-SPECT/CT: White blood cell-single photon emission computed tomography/computed tomography.