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Value of Time-Resolved Cardiac CT in Children and Young Adults with Congenital Heart Disease and Infective
Mohamed Nagiub1, Munes Fares1, Madhusudan Ganigara1
1UT Southwestern Medical Center, Dallas, TX, USA.
Insights
Cardiac CT (CCT) aids in diagnosing infective endocarditis (IE) in children with congenital heart disease (CHD). CCT significantly improves diagnostic accuracy when echocardiography is insufficient, revealing complications and enhancing IE detection rates.
Area of Science:
- Pediatric Cardiology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Diagnosing infective endocarditis (IE) in children with congenital heart disease (CHD) is challenging due to limitations in blood cultures and imaging.
- Transesophageal echocardiography (TEE), the gold standard, faces difficulties in pediatric patients, especially for pulmonary valve vegetations and post-surgical cases.
- Alternative imaging modalities are needed to improve IE diagnosis in this vulnerable population.
Purpose of the Study:
- To evaluate the diagnostic utility of Cardiac CT (CCT) for infective endocarditis (IE) in pediatric patients with congenital heart disease (CHD).
- To assess CCT's role in conjunction with modified Duke criteria (MDC) for IE diagnosis.
- To identify complications of IE detectable by CCT in this cohort.
Main Methods:
- A single-center retrospective study included 14 pediatric patients with CHD and diagnosed IE who underwent CCT between 2018 and 2022.
- Data included patient demographics, cardiac conditions, clinical presentation, echocardiography, CCT findings, and blood cultures.
- Modified Duke Criteria (MDC) were applied with and without CCT findings to determine diagnostic impact.
Main Results:
- Of 14 patients (median age 11 years), 11 (79%) met MDC for definite IE after CCT inclusion, compared to 4 without CCT.
- CCT identified IE in the RV-PA conduit (10 patients) and aortic valve (4 patients).
- CCT revealed complications including thromboembolic findings and pseudoaneurysms (5 each), and prosthetic valve issues (1 each).
Conclusions:
- Cardiac CT (CCT) plays a complementary role to echocardiography in diagnosing IE in pediatric patients with CHD.
- CCT enhances diagnostic accuracy and aids in identifying IE-related complications.
- Further research into reducing radiation exposure could establish CCT as a key diagnostic tool for IE in this population.
Background:
Diagnosis of infective endocarditis (IE) can be challenging due to negative blood cultures and diagnostic limitations of various imaging modalities. Transesophageal echocardiography (TEE) is the gold standard imaging modality for visualization of valvular vegetations. However, due to the anterior location of the pulmonary valve, post-surgical changes, and sedation requirement, TEE can be challenging in the pediatric population. The aim of this study was to assess the value of Cardiac CT (CCT) for diagnosis of IE in children and young adults with congenital heart disease (CHD).
Methods:
This is a single-center retrospective study of pediatric patients with CHD and diagnosis of IE who underwent CCT from 2018 to 2022. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic/CCT findings, and blood culture results. In addition, modified Duke criteria (MDC) for the diagnosis of IE were applied with and without CCT findings as the diagnostic imaging criterion.
Results:
Fourteen patients were included in this study with a median age of 11 years old. Nine patients were female. Ten patients had IE of the RV-PA conduit and four patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. After including CCT findings, 11 patients (79%) met MDC for definite IE. Blood cultures were positive in 12 patients. CCT revealed the following complications: thromboembolic findings/pseudoaneurysms in 5 patients each and prosthetic valve perforation/prosthetic valve leak in one patient each.
Conclusions:
This study reinforces the complimentary role of CCT to echocardiography in the work-up and diagnosis of IE in patients with CHD. With further improvement in lowering radiation exposure, CCT may have a key role in the diagnostic work-up of endocarditis and could be implemented in the diagnostic criteria of IE.
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