Ilona Michałowska1, Patrycjusz Stokłosa2, Małgorzata Miłkowska3, Dariusz Zakrzewski4, Małgorzata Nieznańska5, Paweł Kwiatek6, Sylwia Lewandowska7, Krzysztof Kuśmierski8, Piotr Kołsut9, Mariusz Kuśmierczyk10, Jarosław Kuriata11, Karina Zatorska12, Tomasz Hryniewiecki13. 1. Department of Radiology, National Institute of Cardiology, Warsaw, Poland. Electronic address: imichalowska@ikard.pl. 2. Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland. Electronic address: pstoklosa@ikard.pl. 3. Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland. Electronic address: mmilkowska@ikard.pl. 4. Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland. Electronic address: dzakrzewski@ikard.pl. 5. Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland. Electronic address: mnieznanska@ikard.pl. 6. Department of Radiology, National Institute of Cardiology, Warsaw, Poland. Electronic address: pkwiatek@ikard.pl. 7. Department of Radiology, National Institute of Cardiology, Warsaw, Poland. Electronic address: slewandowska@ikard.pl. 8. Department of Cardiac Surgery and Transplantology, NationalInstitute of Cardiology, Warsaw, Poland. Electronic address: kkusmierczyk@ikard.pl. 9. Department of Cardiac Surgery and Transplantology, NationalInstitute of Cardiology, Warsaw, Poland. Electronic address: pkolsut@ikard.pl. 10. Department of Cardiac Surgery and Transplantology, NationalInstitute of Cardiology, Warsaw, Poland. Electronic address: mkusmierczyk@ikard.pl. 11. Department of Cardiac Surgery and Transplantology, NationalInstitute of Cardiology, Warsaw, Poland. Electronic address: jkuriata@ikard.pl. 12. Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland. Electronic address: kzatorska@ikard.pl. 13. Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland. Electronic address: thryniewiecki@ikard.pl.
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.
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.
Authors: Joop J P Kouijzer; Daniëlle J Noordermeer; Wouter J van Leeuwen; Nelianne J Verkaik; Kirby R Lattwein Journal: Front Cell Dev Biol Date: 2022-10-03