Preoperative evaluation in aortic endocarditis: findings on cardiac CT

Area of Science:

• Cardiovascular Imaging
• Infective Endocarditis Research
• Medical Diagnostics

Background:

• Aortic endocarditis poses significant risks, necessitating accurate preoperative assessment.
• Identifying aortic valvular pseudoaneurysms and vegetations is crucial for surgical intervention planning.

Purpose of the Study:

• To evaluate the feasibility and diagnostic accuracy of preoperative cardiac computed tomography (CT) for aortic valvular pseudoaneurysms and vegetations.
• To assess the capability of cardiac CT in patients with aortic endocarditis requiring surgery.

Main Methods:

• Retrospective analysis of contrast-enhanced CT scans from 19 patients with active aortic endocarditis.
• CT scans were ECG-gated and acquired without beta-blocker administration.
• Systematic comparison of CT findings with intraoperative results.

Main Results:

• Cardiac CT demonstrated high sensitivity and specificity for pseudoaneurysms (100% and 87.5%) and their extension (100%).
• Sensitivity for vegetations was 71.4% and specificity was 100%.
• All vegetations larger than 1 cm were accurately detected (100% sensitivity and specificity).

Conclusions:

• Preoperative cardiac CT is a feasible method for assessing aortic valvular pseudoaneurysms in infective endocarditis.
• CT provides essential data on the presence and relationships of pseudoaneurysms, aiding surgical decisions.
• Further prospective studies comparing CT with transesophageal echocardiography are recommended.