Comparative evaluation of CTCA and TOE in the detection of paravalvular complications in prosthetic valve...

Prosthetic valve infective endocarditis (PVE) is one of the most severe complications after valve implantation. Early diagnosis and identification of paravalvular complications are essential to determine optimal timing of surgery. Our aim is to assess the diagnostic performance of Computed Tomography Coronary Angiography (CTCA) versus Transoesophageal echocardiography (TOE) for the detection of valvular and paravalvular complications of PVE against the reference standard of surgical inspection.

Fifty-two patients who underwent pre-operative CTCA and TOE for the assessment of prosthetic valve IE were included. Imaging findings of vegetation, abscess/pseudoaneurysm, leaflet perforation and dehiscence were compared with intra-operative findings. Significant ancillary findings on CTCA likely to impact surgical planning were also reported.

Median age was 64 years and 66 ​% were male. Surgical inspection revealed vegetations in 39 cases; CTCA had a sensitivity of 81.6 ​% specificity 90.9 ​%, AUC 0.876; TOE had a sensitivity of 97.4 ​%, specificity 72.7 ​%, AUC 0.807. Surgical inspection revealed abscess/pseudoaneurysm in 29 cases; CTCA had a sensitivity of 86.2 ​%, specificity 95.2 ​%, AUC 0.886; TOE had a sensitivity of 55.2 ​%, specificity 90.5 ​% (p ​< ​0.001), AUC 0.749. Significant ancillary findings on CTCA were identified in 24 (46 ​%) of patients.

CTCA demonstrates higher diagnostic accuracy for paravalvular complications of PVE compared to TOE; a critical finding that necessitates early surgical intervention. Additionally, CTCA provides valuable ancillary information that can influence surgical planning. CTCA demonstrates comparable performance to TOE in identifying vegetations. Echocardiography remains superior for evaluating valve perforation, and dehiscence. A combined approach utilising both echocardiography and CTCA is recommended.