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CT in Prosthetic Valve Endocarditis — EECC MCQ

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ModerateCardiac ImagingCT in Prosthetic Valve EndocarditisEECC

A 58-year-old woman with a mechanical mitral valve presents with suspected endocarditis. TOE shows an echogenic mass on the sewing ring but interpretation is difficult due to prosthetic artefact. What additional imaging technique improves detection of perivalvular complications?

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Correct answer: D — Cardiac CT with ECG-gating — provides excellent spatial resolution for detecting perivalvular abscess, pseudoaneurysm, and dehiscence, complementing TOE which has limited views behind prosthetic acoustic shadows

Prosthetic valve endocarditis (PVE) assessment is challenging due to acoustic shadowing from prosthetic materials on echocardiography. ECG-gated cardiac CT provides complementary information: (1) excellent spatial resolution for perivalvular abscess, pseudoaneurysm, fistula, and dehiscence; (2) can image behind prosthetic shadows that limit TOE; (3) quantifies prosthetic valve motion and identifies thrombus/pannus. The 2023 ESC IE Guidelines recommend cardiac CT as a Class IIa investigation when TOE is non-diagnostic or equivocal in suspected PVE. Cardiac MRI is limited by metallic artefact from most mechanical valves. FDG-PET/CT provides functional information about active infection. The multimodality approach (TOE + CT + PET) maximises diagnostic sensitivity for PVE.

Reference: ESC (2023): Guidelines on Infective Endocarditis