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Value of Time-Resolved Cardiac CT in Children and Young Adults with Congenital Heart Disease and Infective Endocarditis

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Abstract

Background

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).

Methods

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.

Results

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.

Conclusions

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.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. UT Southwestern Medical Center, Dallas, TX, USA

    Mohamed Nagiub, Munes Fares, Madhusudan Ganigara, Sana Ullah, Nathan Hsieh, Robert Jaquiss, Jeanne Dillenbeck & Tarique Hussain

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  1. Mohamed Nagiub
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  2. Munes Fares
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  3. Madhusudan Ganigara
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Contributions

MN contributed to data collection, conceptualization, methodology, analysis, writing (initial and review), and visualization. MF contributed to writing (review/editing), supervision, validation, and visualization. MG contributed to writing (review/editing). SU, JD, and RJ contributed to writing (review/editing) and supervision. NH contributed to writing (review/editing) and validation.TH contributed to conceptualization, writing (review/editing), supervision, and validation.

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Correspondence to Tarique Hussain.

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Nagiub, M., Fares, M., Ganigara, M. et al. Value of Time-Resolved Cardiac CT in Children and Young Adults with Congenital Heart Disease and Infective Endocarditis. Pediatr Cardiol (2022). https://doi.org/10.1007/s00246-022-03069-7

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