Multimodality cardiovascular imaging in the diagnosis and management of prosthetic valve infective endocarditis in children report of two cases and brief review of the literature

Abstract

Diagnosing prosthetic valve infective endocarditis in children is challenging. Transthoracic and transesophageal echocardiography can yield false-negative results. Data are lacking in paediatric multimodality imaging in prosthetic valve infective endocarditis. We present two children with repaired CHD where initial echocardiogram was non-diagnostic, while CT angiogram and 18F-fluorodeoxyglucose positron emission tomography in combination with CT angiography, respectively, confirmed the diagnosis of endocarditis affecting clinical management.

Value Of Dual Source Cardiac CT In Children And Young Adults With Congenital Heart Disease And Infective Endocarditis Role of CT in the management of pediatric infective endocarditis

“…CCT was able to reduce the false negative diagnosis rate to 0% and was able to classify 79% of con rmed IE cases as 'de nite IE.' Previous published studies that challenged diagnostic yield of echo (TTE/TEE) against CT or PET for endocarditis were either adult studies (8,11,(17)(18)(19)(20) or pediatric case reports (13).…”

“…Studies for imaging modalities in pediatric infective endocarditis are lacking, since available studies involve patients with adult congenital heart disease (11,12) or consist of isolated case reports in pediatric patients (13). The aim of this study was to assess the value of time-resolved Cardiac CT (CCT) for IE in children and young adults with congenital heart disease (CHD).…”

Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies

“…SPECT/CT imaging relies on the use of autologous radiolabeled leucocytes ( 111 Inoxine or 99m Tc-hexamethyl propylene amine oxime) that accumulate in a time-dependent fashion in late images versus earlier images [33], whereas PET/CT is generally performed using a single acquisition time point (generally at 1 h) after the administration of 18 F-FDG, which is actively incorporated in vivo by the activated leucocytes, monocyte macrophages, and CD4 + T-lymphocytes accumulating at the sites of infection. The main added value of these new imaging techniques is reducing the rate of misdiagnosing IE in patients labeled as possible IE by the Duke criteria and for detecting embolic and metastatic infectious events [34].…”

Pediatric Infective Endocarditis: A Literature Review

“…Advanced cardiovascular imaging modalities such as cardiac magnetic resonance imaging, computed tomography angiography, or positron emission tomography in combination with computed tomography (PET-CT) have gained interest in recent years, due to the lower sensitivity of echocardiography for the diagnosis of IE in children with corrected congenital heart disease, especially those with mechanical prosthetic valves, conduits, stents, or ventricular assist devices [ 55 , 56 , 57 ]. High-resolution multislice gated cardiac CT has a high added value for diagnosing paravalvular complications such as abscess, but there is scarce evidence for the diagnosis of infective endocarditis in children [ 34 ].…”

“…The sensitivity is close to 100% and its reliability has also been demonstrated in children [ 56 , 57 , 61 ]. PET-CT is very useful in detecting septic emboli and also in areas with little clinical expression such as the lungs or the spleen [ 55 ]. Despite its high diagnostic reliability, PET-CT has a number of limitations that must be taken into account [ 62 ]: exposure to ionizing radiation, which have a greater negative impact in children; interference with physiological activity (i.e., central nervous system, reactive intestinal ganglia, etc.…”