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

Abstract

Background: Diagnosis of Infective Endocarditis (IE) can be challenging due to negative blood cultures and difficulties in imaging. Transesophageal echocardiography (TEE) is the gold standard but due to the anterior location of the pulmonary valve and sedation requirement, TEE could be challenging. The aim of this study was to assess the value of Cardiac CT (CCT) for IE in children and young adults with congenital heart disease (CHD). Methods: This is a retrospective review of pediatric patients with CHD and diagnosis of IE who underwent CCT (2018-22). Retrospectively Gated CCT was performed. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic / CCT/ PET findings, and blood culture results. In addition, Modified Duke criteria(MDC) for the diagnosis of IE were applied with and without CCT as the diagnostic imaging criterion. Results: Fourteen patients were included in this study with median age 11 years old. Nine patients were female. Ten of 14 patients had IE of the RV-PA conduit and 4 patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. Including CCT findings 11 patients (79 %) met MDC for definite IE. Blood cultures were positive in 12 patients. CCT revealed the following complications: thromboembolic findings / pseudoaneurysms in 5 patients each and prosthetic valve perforation/ prosthetic valve leak in one patient each. Conclusions: This study reinforces the complimentary role of CCT to echocardiography in the work up and diagnosis of IE in patients with CHD. With further improvement in lower radiation exposure, CCT may have a key role in the diagnostic work up of endocarditis and could be implemented in the diagnostic criteria of IE.