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The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: a case report
- Source :
- European Heart Journal: Case Reports
- Publication Year :
- 2020
- Publisher :
- Oxford University Press (OUP), 2020.
-
Abstract
- 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.
- Subjects :
- 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
Subjects
Details
- ISSN :
- 25142119
- Volume :
- 4
- Database :
- OpenAIRE
- Journal :
- European Heart Journal - Case Reports
- Accession number :
- edsair.doi.dedup.....40c46f7404f4a326c7cc872ebbb3d573