Rottiers Kaat, Rosseel Liesbeth
Department of Cardiology, University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
Department of Cardiology, Azorg, Merestraat 80, 9300 Aalst, Belgium.
Eur Heart J Case Rep. 2024 Dec 16;9(1):ytae667. doi: 10.1093/ehjcr/ytae667. eCollection 2025 Jan.
Patients after transcatheter pulmonary valve implantation (TPVI) are at increased risk for infective prosthetic valve endocarditis. Diagnosis of infective endocarditis (IE) following TPVI is particularly difficult due to impaired visualization of the transcatheter pulmonary valve (TPV) with echocardiography [Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC guidelines for the management of endocarditis. 2023;:3948-4042]. The aim of this case report is to describe the significant role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in diagnosing IE post-TPVI.
A 22-year-old woman presented to the emergency department with fever and chest pain. Relevant past medical history included a left ventricular outflow membrane resection at infancy, a Ross procedure at the age of 4 with post-operative pacemaker implantation and Melody™ TPVI at the age of 16 because of pulmonary valve stenosis. Blood tests showed elevated inflammatory markers. Transthoracic echocardiography revealed elevated systolic pulmonary artery pressure of 53 mmHg. After 2 days, blood cultures appeared positive for species. Subsequently, transoesophageal echocardiography showed an elevated TPV peak gradient (25 mmHg). No clear valvular nor pacemaker lead vegetations were identified but could not be ruled out as inspection of the TPV was difficult. However, 18F-FDG PET/CT demonstrated heightened metabolism at the TPV, which confirmed the diagnosis of TPV IE. Intravenous antibiotic treatment was administered, which led to clinical improvement and normalization of the inflammatory markers.
Transthoracic echocardiography and transoesophageal echocardiography often fail to provide adequate assessment, making 18F-FDG PET/CT crucial for diagnosing TPV IE in this case. Important to notice is the possibility of false-negative and false-positive diagnoses and the radiation exposure, particularly in this young population.
经导管肺动脉瓣植入术（TPVI）后的患者发生人工瓣膜感染性心内膜炎的风险增加。由于经胸超声心动图难以清晰显示经导管肺动脉瓣（TPV），因此TPVI后感染性心内膜炎（IE）的诊断尤为困难[德尔加多V，阿伊莫内·马尔桑N，德瓦哈S，博纳罗斯N，布里达M，伯里H等。2023年欧洲心脏病学会感染性心内膜炎管理指南。2023年；：3948 - 4042]。本病例报告的目的是描述18F - 氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F - FDG PET/CT）在诊断TPVI后IE中的重要作用。
一名22岁女性因发热和胸痛就诊于急诊科。相关既往病史包括婴儿期左心室流出道隔膜切除术、4岁时行罗斯手术并术后植入起搏器，以及16岁时因肺动脉瓣狭窄行Melody™ TPVI。血液检查显示炎症标志物升高。经胸超声心动图显示收缩期肺动脉压升高至53 mmHg。2天后，血培养显示某种菌种呈阳性。随后，经食管超声心动图显示TPV峰值梯度升高（25 mmHg）。未发现明确的瓣膜或起搏器导线赘生物，但由于对TPV的检查困难，不能排除其存在。然而，18F - FDG PET/CT显示TPV代谢增强，从而确诊为TPV IE。给予静脉抗生素治疗，临床症状改善，炎症标志物恢复正常。
经胸超声心动图和经食管超声心动图常常无法提供充分评估，使得18F - FDG PET/CT在本病例中对于诊断TPV IE至关重要。需要注意的是，存在假阴性和假阳性诊断的可能性以及辐射暴露问题，尤其是在年轻人群中。
