PMC6501225_01
Midesophageal short axis view obtained on transesophageal echocardiogram performed on hospital day 3 with a focus on the right atrium, tricuspid valve, and RVOT. There was no clear, identifiable source of infection on this initial evaluation.
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Transthoracic echocardiogram (TTE) on hospital day 1 and TEE on day 3 were, however, noncontributory (Figure 1).
Focused midesophageal view of the RVOT on repeat TEE performed on hospital day 9. Note the large echodense structure measuring 3.4 cm x 1.6 cm that is independent of the tricuspid valve apparatus and is highly mobile with a narrow peduncle. The temporary pacemaker lead is also independent of this structure.
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TEE was then repeated on hospital day 9 revealing a highly mobile echodensity in the right ventricular outflow tract (RVOT) measuring 3.4 cm by 1.6 cm (Figure 2) without valve leaflet or chordae involvement.
Midesophageal RVOT-focused view on intraoperative TEE immediately postaspiration using the AngioVac system (catheter can be visualized in this image.) Although residual vegetation is visible, there is approximately 90% resolution postaspiration.
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Postprocedure TEE showed up to 90% resolution of the mass (Figure 3).