The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report
Autor: | Adam J. Brown, Nancy Khav, Hashrul Rashid |
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Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Transcatheter aortic valve replacement/implantation medicine.medical_treatment Case Reports Prosthesis Valve replacement Case report medicine Endocarditis AcademicSubjects/MED00200 Computed tomography Leaflet thrombosis Cardiac Imaging (Echocardiography / Cardiac MRI / Nuclear Cardiology) Four-Dimensional Computed Tomography Leaflet (botany) business.industry Aortic stenosis valvular heart disease medicine.disease Thrombosis Infective endocarditis cardiovascular system Radiology Cardiology and Cardiovascular Medicine business |
Zdroj: | European Heart Journal: Case Reports |
ISSN: | 2514-2119 |
Popis: | Background Transcatheter aortic valve replacement (TAVR) is becoming increasingly utilized for the treatment of severe aortic valvular heart disease. Infective endocarditis of TAVR is rare but associated with higher mortality and morbidity. The potential for leaflet thrombosis following TAVR is also becoming increasingly recognized. Diagnosis of these conditions on echocardiography can be challenging due to prosthesis artefact. Case summary An 84-year-old man with a previous transcatheter aortic valve replacement presented with a febrile illness and bacteraemia. Transthoracic and transoesophageal echocardiography demonstrated high transvalvular gradients with features of prosthesis endocarditis, though leaflet morphology could not be fully assessed due to prosthesis artefact. Four-dimensional computed tomography revealed hypo-attenuated leaflet thickening with reduced leaflet motion, consistent with prosthesis leaflet thrombosis. The patient was successfully treated with antibiotics and anticoagulation, with resolution of the infection and normalization of the transvalvular gradient after 6 weeks. Discussion Echocardiography should be the first-line investigation for assessing leaflet morphology in suspected prosthetic valve endocarditis or leaflet thrombosis but its accuracy may be limited by artefact. Our case highlights that four-dimensional computed tomography provides further evaluation of prosthesis leaflet morphology/motion, providing valuable diagnostic information. |
Databáze: | OpenAIRE |
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