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Prosthetic valve infective endocarditis — SCE Acute Medicine MCQ

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HardInfectious diseasesProsthetic valve infective endocarditisSCE Acute Medicine

A 58-year-old man with a prosthetic aortic valve has three weeks of fever and a new regurgitant murmur. Three blood-culture sets have been taken before antibiotics. Transthoracic echocardiography is technically adequate but shows no vegetation. Clinical suspicion of prosthetic-valve endocarditis remains high. What is the most appropriate next investigation?

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Correct answer: E — Perform transoesophageal echocardiography to assess the prosthetic valve

Transoesophageal echocardiography is more sensitive than transthoracic imaging for prosthetic-valve vegetations, abscesses and dehiscence. A negative transthoracic study does not exclude endocarditis when pre-test probability remains high. Repeat TOE and adjunctive gated CT or FDG-PET/CT may be needed if the first TOE is non-diagnostic.

Reference: https://www.escardio.org/guidelines/clinical-practice-guidelines/all-esc-practice-guidelines/endocarditis/