Vol 31, No 4 (2024)
Image in Cardiovascular Medicine
Published online: 2024-08-29

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The use of multimodality imaging in infective endocarditis diagnosis

Michał Wrzosek1, Karina Zatorska1, Anna Konopka2, Małgorzata Pastuszek-Tyc3, Paweł Litwiński3, Piotr Trochimiuk4, Tomasz Hryniewiecki1, Ilona Michałowska5
Pubmed: 39212185
Cardiol J 2024;31(4):645-646.

Abstract

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clinicAL CARDIOLOGY

IMAGE IN CADRIOVASCULAR MEDICINE

Cardiology Journal

2024, Vol. 31, No. 4, 645–646

DOI: 10.5603/cj.100016

Copyright © 2024 Via Medica

ISSN 1897–5593

eISSN 1898–018X

The use of multimodality imaging in infective endocarditis diagnosis

Michał Wrzosek1Karina Zatorska1Anna Konopka2Małgorzata Pastuszek-Tyc3Paweł Litwiński3Piotr Trochimiuk4Tomasz Hryniewiecki1Ilona Michałowska5
1Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland
2Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
3Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warsaw, Poland
4Department of Coronary and Structural Heart Disease, National Institute of Cardiology, Warsaw, Poland
5Department of Radiology, National Institute of Cardiology, Warsaw, Poland

Address for correspondence: Michał Wrzosek, MD, Department of Valvular Heart Disease, National Institute of Cardiology, ul. Alpejska 42, 04–628, Warsaw, Poland, phone: +48 22 3434191, e-mail: mwrzosek@ikard.pl

Date submitted: 28.03.2024 Date accepted: 23.07.2024

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

A 65-year-old man after the Bentall procedure (bioprosthesis Perimount 29 mm, Itergard 30 mm, 2018) was hospitalized due to aortic valve infective endocarditis. At admission, the patient complained about the deterioration of heart failure symptoms (up to New York Heart Association class IV) for 2 weeks. The C-reactive protein level was 18.36 mg/dL (normal < 0.5 mg/dL), the B-type natriuretic peptide level 12115 pg/mL (normal < 125 pg/mL), and troponin T 3502 ng/L (nor­mal < 14 ng/L). Two-dimensional transthoracic echocardiography (TTE) revealed mobile echo-dense masses attached to the aortic prosthesis, dehiscence of the valvular prosthesis and its displacement towards the left ventricular outflow tract, severe aortic regurgitation, ascending aorta aneurysm (85 × 59 mm) and reduced left ventricular ejection fraction to 20%. Computed tomography (CT) confirmed prosthetic valve endocarditis. Moreover, CT showed pulmonary edema, bilateral pleural effusion (up to 4.3 cm on the right side, and 3.3 cm on the left side), and foci of splenic infarction. The patient underwent Bentall re-operation (conduit St.Jude 33 mm). Intraoperatively, vegetations around the aortic ring, non-coronary cusp perforation, and aneurysm of the aortic root (8–9 cm) were found. Blood and tissue prosthesis cultures which were obtained during that hospitalization, were negative. Six weeks of empirical antibiotic treatment was implemented. The postoperative TTE showed proper aortic prosthesis function with normal left ventricular ejection fraction. The patient was discharged from the hospital in good clinical condition.

Figure 1. Image in Cardiovascular Medicine. A. Aneurysm of the aortic bulb, Angio-cardiac CT, Cinematic VRT; B. CT axial view, pulmonary edema C. Two-dimensional (2D) TTE (parasternal short axis, PSAX) showing the masses in aortic ring prosthesis; D. Intraoperative view with visible vegetations; E. Angio-cardiac CT, oblique view on aortic valve, hypodense masses (vegetations)