Abstract 15804: Utility of Multi-modal Imaging in the Diagnosis of Pulmonary Valve Endocarditis
Introduction: Definitive echocardiographic evidence is a major criterion for the diagnosis of infective endocarditis by modified Duke Criteria. Pulmonary valve infectious endocarditis (PVIE), however, can be challenging to identify by echo. We sought to evaluate the added utility of multimodal imaging in PVIE.
Methods: We retrospectively analyzed demographic, laboratory, imaging, clinical, and surgical data from patients diagnosed with PVIE (2008-2015). All patients had undergone TEE as well as cardiac MRI or PET/CT and had Duke major and minor criteria evaluated.
Results: A total of 17 patients were identified with definite PVIE (76 % male and ages 4-70 years). Fourteen patients had congenital heart disease with RV to PA conduits; 3 with subsequent transcatheter pulmonary valve implant. Overall, 15/17 (88%) had positive blood cultures: strep spp 6, staph spp 5, HACEK spp 3, enterococcus 1. Only 9/ 17 demonstrated TEE evidence of PVIE. In 8 cases, TEE was negative but showed new PV obstruction and evidence of PVIE was subsequently seen by PET/CT (n=5; see figure, arrow denotes area of abnormality) or cardiac MRI (n=3). Multimodal imaging was significantly better than TEE alone for detection of PVIE (17/17 versus 9/17, p=0.001). PVIE was confirmed by surgery in 14 cases.
Conclusion: The ability to detect endocardial involvement in PVIE by echocardiography is poor, but echo is helpful in identifying new obstruction. Multimodal imaging improves the ability to preoperatively identify endocardial involvement in PVIE. Consideration should be given for PVIE to revise Duke criteria to include new obstruction and endocardial involvement by multimodal imaging.
Author Disclosures: J.S. Li: None. K.D. Hill: None. C.P. Hornik: None. R.A. Krasuski: Consultant/Advisory Board; Modest; Actelion, Bayer. P.C. Barker: None. R.D. Jaquiss: None. M.J. Campbell: None.
- © 2016 by American Heart Association, Inc.