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Boczar KE, Lau L, Hejji N, Wiefels C. Infective Endocarditis: The role of PET imaging in diagnosis and management. J Med Imaging Radiat Sci 2024; 55:S17-S25. [PMID: 38307769 DOI: 10.1016/j.jmir.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 02/04/2024]
Abstract
Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) has recently emerged as an increasingly used alternative and supplementary imaging modality for the diagnosis of infective endocarditis. 18F-FDG PET/CT imaging for IE is given a Class I recommendation (level of evidence B) and is therefore recommended in cases of possible prosthetic valve IE to both detect valvular lesions, as well as confirm the diagnosis of IE. They have also given a class I recommendation (level of evidence B) for brain and whole-body 18F-FDG PET/CT and/or MRI imaging to detect peripheral lesions for patients with either native or prosthetic valve IE. Molecular imaging is playing an increasingly important role in the diagnosis and management of patients with IE. The important role of 18F-FDG PET/CT imaging has been acknowledged by recent guideline updates. These advanced imaging tests are not supplanting the role of echocardiography in the diagnostic pathway for IE. Rather, they are additional tools that are available where the diagnosis is complicated, difficult, or uncertain.
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Affiliation(s)
- Kevin Emery Boczar
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Canada; School of Epidemiology and Public Health, Department of Medicine, University of Ottawa, Canada
| | - Lawrence Lau
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Canada
| | - Nuha Hejji
- University of Ottawa, Department of Medicine, Division of Nuclear Medicine, Canada
| | - Christiane Wiefels
- University of Ottawa, Department of Medicine, Division of Nuclear Medicine, Canada.
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Parato VM, Belleggia S, Parato AG, Ianni U, Molisana M, Gizzi G, D'Agostino S, Dottori M, Di Eusanio M. Multi-valve Libman-Sacks's endocarditis-related multiple, massive and fatal systemic embolization. A case report and a review of diagnostic work-up. Monaldi Arch Chest Dis 2023. [PMID: 37817746 DOI: 10.4081/monaldi.2023.2729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 09/03/2023] [Indexed: 10/12/2023] Open
Abstract
We reported a case of non-bacterial thrombotic endocarditis (NBTE) in a 37-year-old woman who presented with signs and symptoms of cardio-embolic cerebral stroke caused by a prothrombotic state due to underlying advanced uterine cancer. Multimodal imaging, including 3D-ecocardiography, as well as laboratory and cultural tests, were critical in making the diagnosis. After starting anticoagulation therapy with low molecular weight heparin (LMWH), the patient underwent surgical aortic valve replacement due to worsening aortic valve function, initial left ventricle enlargement, increasing dimensions, and mobility of vegetations. Unfortunately, vegetations relapsed on the aortic valve bio-prosthesis as well as the mitral leaflets, resulting in a final picture of multi-valve NBTE. The fatal outcome was due to a massive multiple limb embolism, which resulted in leg amputations and septical complications. Starting with the case, we present a brief overview of the pathology's presentation, treatment, management, and prognosis, as well as the diagnostic work-up.
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Affiliation(s)
- Vito Maurizio Parato
- Cardiology and Rehabilitation Unit, Emergency Department, Madonna del Soccorso Hospital, San Benedetto del Tronto; Post-Graduation School of Cardiovascular Diseases, School of Medicine, Università Politecnica delle Marche, Ancona.
| | - Sara Belleggia
- Post-Graduation School of Cardiovascular Diseases, School of Medicine, Università Politecnica delle Marche, Ancona.
| | | | - Umberto Ianni
- Cardiology and Rehabilitation Unit, Emergency Department, Madonna del Soccorso Hospital, San Benedetto del Tronto.
| | - Michela Molisana
- Cardiology and Rehabilitation Unit, Emergency Department, Madonna del Soccorso Hospital, San Benedetto del Tronto.
| | - Germana Gizzi
- Cardiology and Rehabilitation Unit, Emergency Department, Madonna del Soccorso Hospital, San Benedetto del Tronto.
| | - Simone D'Agostino
- Cardiology and Rehabilitation Unit, Emergency Department, Madonna del Soccorso Hospital, San Benedetto del Tronto.
| | - Melissa Dottori
- Cardiology Unit and Echolab, Cardiovascular Sciences Department, University Hospital Lancisi-Salesi, Ancona.
| | - Marco Di Eusanio
- Cardiac Surgery Unit and Cardiovascular Sciences Department, University Hospital Lancisi-Salesi, Università Politecnica delle Marche, Ancona.
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Alamri F, Eltayeb A, Hamad A, Alamri S, Alamri S, Kaidali W, Tashkandi L, Arbili L, Pergola V, Al Sergani H. A native mitral valve mass beyond imagination. Monaldi Arch Chest Dis 2023. [PMID: 37551101 DOI: 10.4081/monaldi.2023.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 08/09/2023] Open
Abstract
The authors report a case of a patient with a history of IgA nephropathy that, during the admission for pneumonia, was found to have an incidental finding of a huge mitral valve (MV) mass on transthoracic echocardiography. The differential diagnosis was challenging because the clinical scenario raised the suspicion of possible infective endocarditis and the imaging features were suggestive of a myxoma or vegetation. The patient underwent urgent excision of the mass with MV replacement due to the high risk of embolism. Intraoperative findings were consistent with clot or vegetation. Pathology result of thrombus was beyond our imagination and at the best of our knowledge one case only has been reported. Awareness about native MV thrombosis and its etiologic factors, workup, and management is key for better medical and surgical management planning because this condition is extremely rare and challenging in the clinical and imaging arena.
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Affiliation(s)
- Fisal Alamri
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh.
| | - Abdalla Eltayeb
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh.
| | - Alaa Hamad
- College of Medicine, Alfaisal University, Riyadh.
| | - Soaad Alamri
- College of Medicine, Alfaisal University, Riyadh.
| | - Sultan Alamri
- King Saud bin Abdulaziz University for Health Sciences, Riyadh.
| | | | | | - Lana Arbili
- College of Medicine, Alfaisal University, Riyadh.
| | - Valeria Pergola
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua.
| | - Hani Al Sergani
- The Heart Centre, King Faisal Specialist Hospital & Research Center, Riyadh.
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Al Sergani H, Moreo A, Bossone E, Vriz O, Alenazy A, Alshehri A, Al Amri M, Alhamshari A, Alamro B, Galzerano D. Imaging in transcatheter native mitral valve replacement with Tendyne mitral valve system: Echocardiographic pathway for the interventional imager. Monaldi Arch Chest Dis 2022; 93. [PMID: 36069642 DOI: 10.4081/monaldi.2022.2404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/22/2022] Open
Abstract
The interaction between the implanter team and the imager team is critical to the success of transcatheter native mitral valve replacement (TMVR), a novel interventional procedure in the therapeutic arsenal for mitral regurgitation. This imaging scenario necessitates the addition of a new dedicated professional figure, dubbed "the interventional imager," with specific expertise in structural heart disease procedures. As its clinical application grows, knowledge of the various imaging modalities used in the TMVR procedure is required for the interventional imager and beneficial for the interventional implanter team. The purpose of this review is to describe the key steps of the procedural imaging pathway in TMVR using the Tendyne mitral valve system, with an emphasis on echocardiography. Pre-procedure cardiac multimodality imaging screening and planning for TMVR can determine patient eligibility based on anatomic features and measurements, provide measurements for appropriate valve sizing, plan/simulate the access site, catheter/sheath trajectory, and prosthesis positioning/orientation for correct deployment, and predict the risks of potential procedural complications and their likelihood of success. Step-by-step echocardiographic TMVR intraoperative guidance includes: apical access assessment; support for catheter/sheath localization, trajectory and positioning, valve positioning and clocking; post deployment: correct clocking; hemodynamic assessment; detection of perivalvular leakage; obstruction of the left ventricular outlet tract; complications. Knowledge of the multimodality imaging pathway is essential for interventional imagers and critical to the procedure's success.
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Crain MA, Fazi A, Hayanga HK, Cook CC, Ellison MB, Sloyer DA. Intraoperative Three-Dimensional Transesophageal Echocardiography: Reconstruction of Mitral Valve Ring Abscess. J Cardiothorac Vasc Anesth 2022; 36:2563-2567. [PMID: 35125258 DOI: 10.1053/j.jvca.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/15/2021] [Accepted: 10/04/2021] [Indexed: 11/11/2022]
Affiliation(s)
| | - Alyssa Fazi
- Department of Anesthesiology, West Virginia University Medicine, Morgantown, WV
| | - Heather K Hayanga
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University Medicine, Morgantown, WV
| | - Chris C Cook
- Division of Cardiac Surgery, Department of Cardiothoracic and Vascular Surgery, West Virginia University Medicine, Morgantown, WV
| | - Matthew B Ellison
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University Medicine, Morgantown, WV.
| | - Daniel A Sloyer
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology, West Virginia University Medicine, Morgantown, WV
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KÜÇÜK U, ALKAN S, BARUTÇU A. A fatal case of culture-negative late prosthetic mitral valve endocarditis. JOURNAL OF EMERGENCY MEDICINE CASE REPORTS 2022. [DOI: 10.33706/jemcr.1079578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Prosthesis valve dehiscence is one of the most serious complications of prosthetic valves. Despite the improvements in medical and surgical treatments, prosthesis valve dehiscence has high mortality. Due to fatality rates, the early diagnosis and treatment of these patients is required. In this case report, we presented a patient with severe mitral deficiency and acute heart failure following mechanical mitral prosthesis valve dehiscence secondary to culture-negative endocarditis.
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Affiliation(s)
| | - Sevil ALKAN
- Çanakkale On sekiz Mart Üniversitesi Tıp Fakültesi, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Çanakkale
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Galzerano D, Pergola V, J Kinsara A, Vriz O, Elmahi I, Al Sergani A, Khaliel F, Cittadini A, Di Giannuario G, Colonna P. Right-sided infective endocarditis and pulmonary embolism: a multicenter study. Monaldi Arch Chest Dis 2022; 92. [PMID: 35416004 DOI: 10.4081/monaldi.2022.2251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/02/2022] [Indexed: 11/23/2022] Open
Abstract
The incidence of right-sided infective endocarditis (RSIE) is steadily increasing and it has been reported to be associated with high risk of embolic events (EE). Aim of our study was to identify the clinical characteristics of patients with RSIE complicated by PE. Indeed, the identification of patients at high risk of significant PE who will benefit from a more aggressive therapeutic strategy may improve the prognosis. From January 2015 to September 2020, 176 patients (Pts) in 6 centers were found to have definite RSIE complicated by PE. Advanced imaging for PE including computed tomography pulmonary angiography (CTPA) was performed in 28 pts (16%) who represent our study group (24 male, mean age 50.6 ±18.29 years). They all underwent transesophageal echocardiography (TEE), in 12 cases (43%) also three-dimensional (3D) TEE, and 27 patients (99%) had both TEE and transthoracic echocardiography (TTE). A total of 53 vegetations (V) were detected. In 18 pts (64%) two or more vegetations were found. Native tricuspid valve was the most frequently involved valve (38 V, 71.7%), followed by catheter (5 V, 9.4%), tricuspid valve prosthesis (4 V, 7.5%), chordae and papillary muscle (2 V, 3.8%) and one vegetation (9%) in each of the following: pulmonic valve, inferior vena cava, eustachian valve, and right atrium. The most common location for vegetations was the anterior leaflet of the tricuspid valve (19 V, 35.8 %) followed by the posterior leaflet (11 V, 20.8%). The most common vegetations morphology was raceme-like shaped (35.8%). Staphylococcus aureus (S. aureus) was the most common causative pathogen (14 pts, 50%). The incidence of PE was very high in patients with vegetation length above 1.5 cm (median 17.6±6.5 mm by TEE). Our results suggest that a routine CTPA should be advised in the presence of vegetations larger than 1.5 cm and with S. aureus infection. This behavior would identify patients at high risk of PE who will benefit from a more aggressive therapeutic strategy, leading to an improvement in the prognosis. Further prospective studies are required to better confirm our hypothesis.
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Abstract
The management of infective endocarditis is complex and inherently requires multidisciplinary cooperation. About half of all patients diagnosed with infective endocarditis will meet the criteria to undergo cardiac surgery, which regularly takes place in urgent or emergency settings. The pathophysiology and clinical presentation of infective endocarditis make it a unique disorder within cardiac surgery that warrants a thorough understanding of specific characteristics in the perioperative period. This includes, among others, echocardiography, coagulation, bleeding management, or treatment of organ dysfunction. In this narrative review article, the authors summarize the current knowledge on infective endocarditis relevant for the clinical anesthesiologist in perioperative management of respective patients. Furthermore, the authors advocate for the anesthesiologist to become a structural member of the endocarditis team.
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L'Acqua C, Piazzoni N, Muratori M, Mazzanti V. Intraoperative 3D TrueVue transesophageal echo imaging in cardiac mass: Bridge between cardiac anesthesiologist and surgeon. Ann Card Anaesth 2022; 25:241-243. [PMID: 35417982 PMCID: PMC9244262 DOI: 10.4103/aca.aca_213_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review. Medicina (B Aires) 2021; 58:medicina58010023. [PMID: 35056331 PMCID: PMC8779064 DOI: 10.3390/medicina58010023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/19/2021] [Accepted: 12/22/2021] [Indexed: 01/10/2023] Open
Abstract
Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application.
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Eleyan L, Khan AA, Musollari G, Chandiramani AS, Shaikh S, Salha A, Tarmahomed A, Harky A. Infective endocarditis in paediatric population. Eur J Pediatr 2021; 180:3089-3100. [PMID: 33852085 DOI: 10.1007/s00431-021-04062-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/26/2021] [Accepted: 04/04/2021] [Indexed: 12/16/2022]
Abstract
Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture-negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort. What is Known: • The current diagnostic techniques including 'Duke's criteria' for paediatric infective endocarditis diagnosis • The current management guidelines utilised for paediatric infective endocarditis What is New: • The long-term outcomes of patients that underwent medical and surgical intervention • The quality of life of paediatric patients that underwent medical and surgical intervention.
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Affiliation(s)
- Loay Eleyan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Ameer Ahmed Khan
- School of Medicine, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK
| | - Gledisa Musollari
- Imperial College London, Exhibition Road, South Kensington, London, SW7 2BU, UK
| | | | - Simran Shaikh
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Ahmad Salha
- St. Georges University of London, Cranmer Terrace, Tooting, London, SW17 0RE, UK
| | - Abdulla Tarmahomed
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, UK
| | - Amer Harky
- Department of Congenital Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK. .,Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK.
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