-
Views
-
Cite
Cite
Laurens E Swart, Jolien W Roos-Hesselink, Roelf Valkema, Carolina A M Schurink, Ricardo P J Budde, Hybrid 18F-fluorodeoxyglucose positron emission tomography/CT angiography in percutaneous pulmonary prosthetic valve endocarditis, European Heart Journal - Cardiovascular Imaging, Volume 19, Issue 10, October 2018, Pages 1188–1189, https://doi.org/10.1093/ehjci/jey082
Close - Share Icon Share
Extract
A 25-year-old man with a history of pulmonary atresia combined with a ventricular septal defect was referred to our centre for suspicion of prosthetic heart valve endocarditis. Three years ago, a percutaneous pulmonary valve (Melody®, Medtronic) had been implanted to replace his homograft because of severe pulmonary insufficiency.
At admission, his temperature was 40°C, oxygen saturation 93% (3 L O2), and parameters of infection were elevated (CRP 177 mg/L, WBC 18 × 109/L). Blood cultures were positive for Staphylococcus aureus within a day. Both transthoracic and transoesophageal echocardiography, however, did not show any signs of endocarditis or changes in valve function (Panel G, *Melody; Supplementary data online, Video S1). The patient was started on flucloxacillin 12 g/day and an 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) and pulmonary CT angiography (CTA) were performed in accordance with the most recent European Society of Cardiolog (ESC) guidelines.
There were no signs of pulmonary emboli, but a vegetation of approximately 8 mm was identified on the valve leaflets (Panels B and F, arrows). Moreover, PET/CT (Panel C) revealed intense 18F-FDG uptake around the prosthetic valve at the level of the valve leaflets (Panels A and E, arrowheads; Supplementary data online, Video S2), which persisted on the non-attenuation-corrected images (Panel D), thereby ruling out metal-induced attenuation-correction artefacts and confirming the diagnosis. The maximum standardized uptake value (SUVmax) and ratio between the SUVmax and the mean SUV in the blood pool were 3.07 and 3.23, respectively (see Supplementary data online, Figure S1). Because of many previous cardiothoracic interventions, haemodynamic stability, absence of structural damage, and a good preliminary response to antibiotics, a conservative treatment was deemed most appropriate by our multidisciplinary Endocarditis Team, and 600 mg of rifampicin twice daily was added. In this case, where echocardiography fell short, combined PET/CTA allowed for a swift and comprehensive diagnosis.
