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Diagnosing infection of extracardiac conduit in children
1Department of Pediatrics, National Cardiovascular Center, Osaka, Japan.
Insights
Infection of extracardiac conduits in children can be challenging to diagnose. Gallium-67 (67Ga) imaging demonstrated higher sensitivity than echocardiography for detecting conduit infection, aiding in early diagnosis.
Area of Science:
- Cardiology
- Pediatric Surgery
- Nuclear Medicine
Background:
- Extracardiac conduits are used for right ventricular outflow tract reconstruction in pediatric patients.
- Postoperative persistent fever and elevated acute-phase reactants can indicate complications.
- Diagnosing infection in these conduits is crucial for timely intervention.
Purpose of the Study:
- To compare the diagnostic efficacy of blood cultures, echocardiography, and 67Ga imaging in identifying extracardiac conduit infections.
- To evaluate the sensitivity and specificity of these diagnostic modalities.
Main Methods:
- Retrospective analysis of 10 pediatric patients with suspected extracardiac conduit infection.
- Utilized blood cultures, echocardiography, and 67Ga imaging for diagnosis.
- Assessed diagnostic performance based on clinical outcomes.
Main Results:
- Gallium-67 (67Ga) imaging detected infection in 9 out of 10 patients, showing abnormal uptake in the conduit area.
- Echocardiography identified conduit infection in only 2 patients by detecting vegetation.
- Blood cultures had a sensitivity of 70% and specificity of 92% for diagnosing infection.
Conclusions:
- 67Ga imaging offers superior sensitivity compared to echocardiography for diagnosing extracardiac conduit infections in children.
- A combination of diagnostic tools may be necessary for comprehensive evaluation.
- Early and accurate diagnosis of conduit infection is vital for patient management.
Abstract:
Between August 1985 and July 1992, at our center, 142 Japanese children had an extracardiac conduit operation to reconstruct the right ventricular outflow tract. The study group consisted of 22 of these 142 children who had a persistent fever and whose serum was positive for acute-phase reactants after the operation. We present the diagnostic findings for 10 children with infection of an extracardiac conduit that had been placed to restore the continuity of the right ventricle-pulmonary artery. They were part of the group of 22 children who were followed over the past 7 years with blood cultures, echocardiography, and 67Ga imaging. All 10 developed a persistent fever and were seropositive for acute-phase reactants. Conduit infection was diagnosed in only 2 patients by the detection of vegetation on echocardiography and was diagnosed in 9 of the 10 patients by an abnormal 67Ga uptake in the area of the artificial vessels used to reconstruct the pulmonary artery. The present study compared the use of blood cultures, echocardiography, and 67Ga imaging in diagnosing an infection of the extracardiac conduit. The sensitivity of blood cultures in diagnosing an extracardiac conduit infection was 70% (7/10), and the specificity was 92% (1/12). 67Ga imaging showed a higher sensitivity than echocardiography in diagnosing infection of an extracardiac conduit.