The role of cardiac computed tomography in the diagnosis of prosthetic valve endocarditis – A comparison with transthoracic and transesophageal echocardiography and intra-operative findings. Issue 138 (May 2021)

• Record Type: Journal Article
• Authors: Michałowska, Ilona; Stokłosa, Patrycjusz; Miłkowska, Małgorzata; Zakrzewski, Dariusz; Nieznańska, Małgorzata; Kwiatek, Paweł; Lewandowska, Sylwia; Kuśmierski, Krzysztof; Kołsut, Piotr; Kuśmierczyk, Mariusz; Kuriata, Jarosław; Zatorska, Karina; Hryniewiecki, Tomasz
• Is Part Of: European journal of radiology. Issue 138(2021)
• Publication Date: 2021-05
• Subjects: Prosthetic valve endocarditis -- Cardiac computed tomography -- Transthoracic echocardiography -- Transesophageal echocardiography; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2021.109637
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: CT is superior to TTE, TEE in diagnosis of pseudoanerysm, vegetations, infiltration. TTE, TEE has higher diagnostic value to CT in the evaluation of paravalvular leakage. Cardiac CT combined with echocardiography improves the diagnostic accuracy of PVE. Abstract: Background: Infective endocarditis is one of the most severe complications after prosthetic valve implantation and an accurate diagnosis is a clinical challenge. The purpose was to assess the diagnostic usefulness of cardiac computed tomography (CT) in valvular and perivalvular complications in patients with prosthetic valve endocarditis (PVE) and to compare CT results with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE) and intraoperative findings. Methods: The retrospective study included 44 consecutive patients with PVE who underwent cardiac surgery. The mean age was 59.6 ± 12.9 years, 33 (75 %) were males. The presence of vegetations, abscess/pseudoaneurysm, paravalvular leakage (PVL) and inflammatory infiltration were evaluated by TTE, TEE and CT prior to surgery and the results were compared with intraoperative findings. Results: Endocarditis affected 47 valves (26 mechanical, 21 biological) in 44 patients. PVE most often affected the aortic valve (n = 36), followed by the mitral valve (n = 9) and the pulmonary valve (n = 2). In the per-valve analysis, the sensitivity of TTE, TEE and CT in diagnosing vegetations was 65 %, 91 % and 96 %; abscess 44 %, 77 % and 89 %; paravalvular leakage 90 %, 100 % and 70 %; inflammatory infiltration 39 %, 56 % and 78 %, respectively. The combination of CT and echocardiography allowed the detection of abscesses/pseudoaneurysms and inflammatory infiltration in all cases except one. Conclusion: CT was superior to echocardiography in the diagnosis of paravalvular abscesses, vegetations and inflammatory infiltration. Echocardiography had a higher diagnostic value to CT in the evaluation of paravalvular leakage. Cardiac CT combined with echocardiography improves the diagnostic accuracy of PVE and both modalities should be performed.