Bui Son Tran Thanh, Duong Hung Duc, Vu Thom Thi, Phan Nam Thanh, Nguyen Anh Van, Mai Son Hong, Nguyen Hoai Thi Thu
Hanoi Medical University, 1 Ton That Tung st., Dong Da, Hanoi, Viet Nam.
Vietnam Heart Institute, Bach Mai Hospital, 78 Giai Phong st., Dong Da, Hanoi, Viet Nam.
Ann Med Surg (Lond). 2022 Jul 31;80:104238. doi: 10.1016/j.amsu.2022.104238. eCollection 2022 Aug.
Prosthetic valve infective endocarditis (PVE) is a diagnostic challenge even in the era of multimodality cardiovascular imaging.
The patient was a 67-year-old male with a three-year history of bioprosthetic aortic valve replacement who presented with persistent fever and negative blood cultures. The initial transthoracic echocardiography revealed a thickened aortic root. An abscess formation was visualized upon subsequent three-dimensional transesophageal echocardiography and positron emission tomography/computerized tomography (PET/CT). The patient underwent an urgent necrotic tissue debridement and a redo Bentall surgery. The real-time polymerase chain reaction of excised tissues was positive for .
The diagnosis of PVE and its complications requires the integration of clinical, microbiological, and serial imaging data. Although advanced imaging modalities like PET/CT allow a timely diagnosis and management, their routine use in resource-limited scenarios is difficult.
Multimodality cardiovascular imaging plays an important role in the diagnosis of PVE. Serial echocardiographic and clinical assessments are possible alternatives when the access to advanced cardiovascular imaging modalities is limited.
即使在多模态心血管成像时代，人工瓣膜感染性心内膜炎（PVE）仍是一项诊断挑战。
该患者为一名67岁男性，有生物人工主动脉瓣置换三年病史，表现为持续发热且血培养阴性。最初的经胸超声心动图显示主动脉根部增厚。随后的三维经食管超声心动图及正电子发射断层扫描/计算机断层扫描（PET/CT）显示有脓肿形成。患者接受了紧急坏死组织清创及再次Bentall手术。切除组织的实时聚合酶链反应呈阳性。
PVE及其并发症的诊断需要整合临床、微生物学及系列成像数据。尽管像PET/CT这样的先进成像方式能实现及时诊断和管理，但在资源有限的情况下常规使用它们存在困难。
多模态心血管成像在PVE诊断中起重要作用。当无法使用先进心血管成像方式时，系列超声心动图和临床评估是可行的替代方法。
