P151 UTILITY OF MULTIMODALITY IMAGING IN A CASE OF MULTIPLE AORTIC POST–ENDOCARDITIS PSEUDOANEURYSMS

Abstract

Abstract Introduction First–line therapy for infective endocarditis is antibiotic treatment to avoid the occurrence of complications such as septic embolization, septic shock (1), pseudoaneurysm or abscess formation (1). A pseudoaneurysm is a cavity that communicates with the vascular lumen and develops as a result of necrosis of the infected tissue (1). Case report: An 81–year–old man with past medical history of aortic valve replacement with bioprosthesis for severe stenosis and re–intervention for infective Enterococcus faecalis endocarditis was admitted to hospital for hyperpyrexia. PET–CT scan was performed. An aortic bioprosthesis hypercaptation suggestive of endocarditis recurrence was found. Blood cultures were positive for Staphylococcus epidermidis. Transesophageal echocardiography was initially negative for vegetations. Therefore, it was decided for a conservative approach with antibiotic therapy. About 2 months later the patient presented in our emergency department with atypical chest pain. At a transthoracic echocardiogram was reported an eccentric paravalvular regurgitation jet on bioprosthesis in atypical position and thickening of the periaortic tissue (Fig 1A). A contrast enhanced cardio–synchronized CT scan was performed confirming the presence of three paravalvular aortic pseudoaneurysms, the largest of 16x8 mm and located on the posterolateral portion of the valvular ring near to the left atrial wall (Fig 1B). Finally, a transesophageal echocardiogram was repeated finding a fistula from the posterior pseudoaneurysm to the left ventricular outflow tract (Fig 1C). The patient underwent re–intervention of aortic valve and ascending aorta replacement. Conclusions In this case–report, the use of multimodality imaging allowed adequate diagnosis of fistulizing paravalvular aortic pseudoaneurysms and proper subsequent surgical planning. The results of this case report suggest that following infective endocarditis presence of paravalvular aortic regurgitation with eccentric jet should be investigated with second–level diagnostic examinations for better anatomic resolution, such as cardio–synchronized CT and transesophageal echocardiogram. Bibliography: 1. Okada K et al. doi: 10.1007/s11748–012–0152–x