Abstract 13294: Role of Retrospective Cardiac Computed Tomography Angiography in the Detection of Prosthetic Valve Endocarditis

Abstract

Case presentation A 47-year-old man was readmitted for evaluation of recurrent fevers, night sweats, and weight loss over a 3 month period. He had a history of bioprosthetic aortic and mitral valve replacements for rheumatic valve disease and heart failure with reduced ejection fraction due to non-ischemic cardiomyopathy. Physical examination was remarkable for a[LMD1] grade II/VI systolic murmur. Laboratory notable for neutrophilic leukocytosis elevated C-reactive protein and erythrocyte sedimentation rate. Blood cultures demonstrated Staphylococcus epidermidis . On transthoracic echocardiogram (TTE) performed in the current admission and transesophageal echocardiogram (TEE) done 2 months prior the prosthetic valves were not clearly visualized, but there was no regurgitation, stenosis or vegetation noted. Due to a high index of suspicion for prosthetic valve endocarditis (PVE), a retrospectively gated cardiac computed tomography angiography (CCTA) of the entire cardiac cycle was performed. It revealed a 13 mm mobile vegetation attached to the ventricular side of the left coronary cusp (Figure 1). Subsequently, the patient underwent a redo aortic valve replacement. Blood cultures cleared and the patient was discharged on hospital day 16 to complete 6 weeks of Cefazolin and Rifampin. Discussion: The modified Duke criteria play an important role in the diagnosis of native valve infective endocarditis (IE) (~ 80% sensitive), but it carries a lower diagnostic yield in the detection of PVE. While TEE carries high accuracy in the diagnosis of native valve endocarditis, approximately 30% of patients with PVE and/or intra-cardiac devices have inconclusive or normal echocardiographic findings. Inability to recognize IE in a timely fashion (<4 days) leads to greater embolic events. We showed how CCTA can be used to expedite the diagnosis of PVE.