Multimodality imaging in the diagnosis of bioprosthetic aortic valve endocarditis: A case report

Son Tran Thanh Bui; Hung Duc Duong; Thom Thi Vu; Nam Thanh Phan; Anh Van Nguyen; Son Hong Mai; Hoai Thi Thu Nguyen

doi:10.1016/j.amsu.2022.104238

Multimodality imaging in the diagnosis of bioprosthetic aortic valve endocarditis: A case report

Ann Med Surg (Lond). 2022 Jul 31:80:104238. doi: 10.1016/j.amsu.2022.104238. eCollection 2022 Aug.

Authors

Son Tran Thanh Bui¹, Hung Duc Duong², Thom Thi Vu³, Nam Thanh Phan², Anh Van Nguyen^{1

2}, Son Hong Mai⁴, Hoai Thi Thu Nguyen^{2

3}

Affiliations

¹ Hanoi Medical University, 1 Ton That Tung st., Dong Da, Hanoi, Viet Nam.
² Vietnam Heart Institute, Bach Mai Hospital, 78 Giai Phong st., Dong Da, Hanoi, Viet Nam.
³ VNU - University of Medicine and Pharmacy, 144 Xuan Thuy st., Cau Giay, Hanoi, Viet Nam.
⁴ 108 Military Central Hospital, 1B Tran Hung Dao st., Hai Ba Trung, Hanoi, Viet Nam.

Abstract

Introduction: Prosthetic valve infective endocarditis (PVE) is a diagnostic challenge even in the era of multimodality cardiovascular imaging.

Case presentation: The patient was a 67-year-old male with a three-year history of bioprosthetic aortic valve replacement who presented with persistent fever and negative blood cultures. The initial transthoracic echocardiography revealed a thickened aortic root. An abscess formation was visualized upon subsequent three-dimensional transesophageal echocardiography and positron emission tomography/computerized tomography (PET/CT). The patient underwent an urgent necrotic tissue debridement and a redo Bentall surgery. The real-time polymerase chain reaction of excised tissues was positive for Streptococcus.

Clinical discussion: The diagnosis of PVE and its complications requires the integration of clinical, microbiological, and serial imaging data. Although advanced imaging modalities like PET/CT allow a timely diagnosis and management, their routine use in resource-limited scenarios is difficult.

Conclusion: Multimodality cardiovascular imaging plays an important role in the diagnosis of PVE. Serial echocardiographic and clinical assessments are possible alternatives when the access to advanced cardiovascular imaging modalities is limited.

Keywords: 18F-FDG PET/CT, 18F-fluorodeoxyglucose positron emission tomography/computerized tomography; 3D-TEE, Three-dimensional transesophageal echocardiography; AVR, Aortic valve replacement; Aortic thickening; Bioprosthetic valve; CBC, Complete blood count; CRP-hs, High sensitivity C-reactive protein; ESC, European Society of Cardiology; Echocardiography; IE, Infective endocarditis; Infective endocarditis; LMIC, Low-and-middle-income country; MSCT, Multislice computerized tomography; Multimodality; NVE, Native valve endocarditis; PVE, Prosthetic valve endocarditis; RT-PCR, Real-time polymerase chain reaction; SUVmax, Maximal standardized uptake value; TEE, Transesophageal echocardiography; TTE, Transthoracic echocardiography.

Publication types

Case Reports