The important but underappreciated transgastric right ventricular inflow view for transesophageal echocardiographic evaluation of cardiac implantable device infections

Device infection is a potential complication of cardiovascular implantable electronic devices. We report a case of a 40-year-old man with nonischemic cardiomyopathy, status post biventricular implantable cardiac defilbrillator placement on continuous home dobutamine, who presented with methicillin- resistant Staphylococcus aureus bacteremia. Transesophageal echocardiography showed a 2.4 cm vegetation near the right ventricular (RV) apex that was only seen in the transgastric RV inflow view. This case demonstrates an atypical distal location for a vegetation and illustrates the importance of obtaining multiple views, including the transgastric RV inflow view, when evaluating for device wire vegetations. Device infection is a potential complication of cardiovascular implantable electronic devices. We report a case of a 40-year-old man with nonischemic cardiomyopathy, status post biventricular implantable cardiac defilbrillator placement on continuous home dobutamine, who presented with methicillin-resistant Staphylococcus aureus bacteremia. Transesophageal echocardiography showed a 2.4 cm vegetation near the right ventricular (RV) apex that was only seen in the transgastric RV inflow view. This case demonstrates an atypical distal location for a vegetation and illustrates the importance of obtaining multiple views, including the transgastric RV inflow view, when evaluating for device wire vegetations.