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Cardiol J
Cardiol J
Cardiology Journal
1897-5593
1898-018X
Via Medica

39212185
10.5603/cj.100016
cardj-31-4-645
Clinical Cardiology
Image in Cadriovascular Medicine: The use of multimodality imaging in infective endocarditis diagnosis
Wrzosek Michał 1
Zatorska Karina 1
Konopka Anna 2
Pastuszek-Tyc Małgorzata 3
Litwiński Paweł 3
Trochimiuk Piotr 4
Hryniewiecki Tomasz 1
Michałowska Ilona 5
1 Department of Valvular Heart Disease, National Institute of Cardiology, Warsaw, Poland
2 Department of Intensive Cardiac Therapy, National Institute of Cardiology, Warsaw, Poland
3 Department of Cardiac Surgery and Transplantology, National Institute of Cardiology, Warsaw, Poland
4 Department of Coronary and Structural Heart Disease, National Institute of Cardiology, Warsaw, Poland
5 Department of Radiology, National Institute of Cardiology, Warsaw, Poland
Address for correspondence: Michał Wrzosek, MD, Department of Valvular Heart Disease, National Institute of Cardiology, ul. Alpejska 42, 04–628, Warsaw, Poland, phone: +48 22 3434191, e-mail: mwrzosek@ikard.pl
2024
29 8 2024
31 4 645646
28 3 2024
23 7 2024
Copyright © 2024 Via Medica
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
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pmcA 65-year-old man after the Bentall procedure (bioprosthesis Perimount 29 mm, Itergard 30 mm, 2018) was hospitalized due to aortic valve infective endocarditis. At admission, the patient complained about the deterioration of heart failure symptoms (up to New York Heart Association class IV) for 2 weeks. The C-reactive protein level was 18.36 mg/dL (normal < 0.5 mg/dL), the B-type natriuretic peptide level 12115 pg/mL (normal < 125 pg/mL), and troponin T 3502 ng/L (normal < 14 ng/L). Two-dimensional transthoracic echocardiography (TTE) revealed mobile echodense masses attached to the aortic prosthesis, dehiscence of the valvular prosthesis and its displacement towards the left ventricular outflow tract, severe aortic regurgitation, ascending aorta aneurysm (85 × 59 mm) and reduced left ventricular ejection fraction to 20%. Computed tomography (CT) confirmed prosthetic valve endocarditis. Moreover, CT showed pulmonary edema, bilateral pleural effusion (up to 4.3 cm on the right side, and 3.3 cm on the left side), and foci of splenic infarction. The patient underwent Bentall re-operation (conduit St.Jude 33 mm). Intraoperatively, vegetations around the aortic ring, non-coronary cusp perforation, and aneurysm of the aortic root (8–9 cm) were found. Blood and tissue prosthesis cultures which were obtained during that hospitalization, were negative. Six weeks of empirical antibiotic treatment was implemented. The postoperative TTE showed proper aortic prosthesis function with normal left ventricular ejection fraction. The patient was discharged from the hospital in good clinical condition.

Figure 1 Image in Cardiovascular Medicine. A. Aneurysm of the aortic bulb, Angio-cardiac CT, Cinematic VRT; B. CT axial view, pulmonary edema C. Two-dimensional (2D) TTE (parasternal short axis, PSAX) showing the masses in aortic ring prosthesis; D. Intraoperative view with visible vegetations; E. Angio-cardiac CT, oblique view on aortic valve, hypodense masses (vegetations)
