UT Southwestern Medical Center, Dallas, TX, USA.
Pediatr Cardiol. 2024 Aug;45(6):1267-1274. doi: 10.1007/s00246-022-03069-7. Epub 2022 Dec 19.
Diagnosis of infective endocarditis (IE) can be challenging due to negative blood cultures and diagnostic limitations of various imaging modalities. Transesophageal echocardiography (TEE) is the gold standard imaging modality for visualization of valvular vegetations. However, due to the anterior location of the pulmonary valve, post-surgical changes, and sedation requirement, TEE can be challenging in the pediatric population. The aim of this study was to assess the value of Cardiac CT (CCT) for diagnosis of IE in children and young adults with congenital heart disease (CHD).
This is a single-center retrospective study of pediatric patients with CHD and diagnosis of IE who underwent CCT from 2018 to 2022. Data collected included age, gender, cardiac diagnosis, clinical presentation, echocardiographic/CCT findings, and blood culture results. In addition, modified Duke criteria (MDC) for the diagnosis of IE were applied with and without CCT findings as the diagnostic imaging criterion.
Fourteen patients were included in this study with a median age of 11 years old. Nine patients were female. Ten patients had IE of the RV-PA conduit and four patients had IE of the aortic valve. Using MDC, 4 patients had definite IE. After 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.
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 lowering 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.
由于血培养阴性和各种影像学方式的诊断局限性，感染性心内膜炎（IE）的诊断具有挑战性。经食管超声心动图（TEE）是瓣膜赘生物可视化的金标准影像学方式。然而，由于肺动脉瓣的前位、手术后的改变和镇静的要求，TEE 在儿科人群中可能具有挑战性。本研究旨在评估心脏 CT（CCT）在诊断先天性心脏病（CHD）儿童和年轻成人 IE 中的价值。
这是一项回顾性的单中心研究，纳入了 2018 年至 2022 年间接受 CCT 检查的患有 CHD 和 IE 诊断的儿科患者。收集的数据包括年龄、性别、心脏诊断、临床表现、超声心动图/CCT 结果和血培养结果。此外，应用改良的 Duke 标准（MDC），并将有无 CCT 结果作为诊断影像学标准，对 IE 进行诊断。
本研究纳入了 14 例患者，中位年龄为 11 岁。9 例为女性。10 例患者为 RV-PA 导管 IE，4 例患者为主动脉瓣 IE。使用 MDC，4 例患者为明确 IE。纳入 CCT 结果后，11 例（79%）患者符合明确 IE 的 MDC。12 例患者血培养阳性。CCT 显示以下并发症：5 例患者各有血栓栓塞表现/假性动脉瘤，1 例患者各有假体瓣膜穿孔/假体瓣膜渗漏。
本研究强调了 CCT 在 CHD 患者 IE 检查和诊断中的补充作用。随着辐射暴露的进一步降低，CCT 在感染性心内膜炎的诊断评估中可能具有关键作用，并可纳入 IE 的诊断标准。
