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Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
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[Complicated transcatheter aortic-valve endocarditis with abscess and pseudoaneurysm: Value of the ECG-gated

S Pichard1, G Gibault-Genty2, A Vienet-Legue2

  • 1Service de cardiologie, unité de soins intensif cardiologiques et cardiologie interventionnelle, hôpital Victor-Dupouy, centre hospitalier d'Argenteuil, 95100 Argenteuil, France.

Annales De Cardiologie Et D'Angeiologie
|October 21, 2017
PubMed

Insights

This case highlights how multidetector CT angiography (MDCTA) aids in diagnosing cardiac prosthesis endocarditis, revealing a pseudo-aneurysm missed by echocardiography in a patient with a transcatheter aortic valve implantation.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Infectious Diseases

Background:

  • Transcatheter aortic valve implantation (TAVI) is a common procedure for aortic stenosis.
  • Bioprosthetic valve endocarditis is a serious complication following TAVI.
  • Early and accurate diagnosis is crucial for patient outcomes.

Observation:

  • An 80-year-old male presented with acute infero-lateral ST-elevation myocardial infarction (STEMI).
  • Coronary angiography revealed thrombotic occlusion of the second left marginal branch.
  • Infectious context and recent TAVI prompted suspicion of bioprosthesis endocarditis, confirmed by echocardiography showing aortic-mitral curtain abscess and vegetations.

Findings:

  • ECG-gated multidetector CT angiography (MDCTA) identified a 20-22mm pseudo-aneurysm from the left ventricle outflow tract to the aorta.
  • MDCTA provided crucial information beyond echocardiography, overcoming prosthetic material and calcification artifacts.
  • Enterococcus faecalis bacteremia was associated with the endocarditis.

Implications:

  • MDCTA is vital for diagnosing and evaluating cardiac prosthesis endocarditis, especially when echocardiography is limited by artifacts.
  • This imaging modality offers superior visualization of complex complications like pseudo-aneurysms.
  • Prompt diagnosis and intervention, including valve replacement, are essential for managing this severe complication.

Keywords:
(ECG)-gated multidetector CT angiographyBioprosthesisBioprothèseEndocarditeEndocarditisPseudo-aneurysmPseudo-anévrysmeScanner cardiaqueTAVI

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