Three-dimensional transesophageal echocardiographic imaging of mitral valve bioprosthesis leaflets perforation due to infective endocarditis.

Echocardiography, three-dimensional; echocardiography, transesophageal; heart valve prosthesis; endocarditis. Echogardiographic aspects have been added to the criteria used to investigate the diagnosis of infective endocarditis1. However, under some circumstances, the two-dimensional echocardiographic technique, whether transthoracic or transesophageal, fails to provide sufficient diagnostic information. We report the case of a 43-year old patient with a biological prosthesis in the mitral position, who presented an episode of infective endocarditis with positive blood cultures for Staphylococcus aureus. The patient underwent two-dimensional transthoracic and transesophageal echocardiographic investigation and later to three-dimensional transesophageal reconstruction. The perforation of the leaflets of the bioprosthesis was evidenced only after the three-dimensional echocardiographic analysis was carried out (Figure 1). The patient underwent bioprosthesis replacement, and discharged from hospital seven weeks after the surgery. Three-dimensional echocardiography adds diagnostic information as it allows the study of the heart from multiplane structural observation2,3.