Multislice CT can help guide surgery for infective endocarditis


NEW YORK (Reuters Health), Feb 13 - In patients with infective endocarditis, the accuracy of multislice CT for detecting valvular abnormalities is close to that of transesophageal echocardiography (TEE), and the newer technique could help in surgical planning, according to a report in the February 3 Journal of the American College of Cardiology.

"Multislice CT is a new technique with a promising potential," Dr. Gudrun Feuchtner from Innsbruck Medical University, Innsbruck, Austria, told Reuters Health. "The main advantage of CT is the comprehensive evaluation of coronary arteries, valves, and function noninvasively."

Feuchtner and colleagues compared CT with TEE for visualizing valvular abnormalities in 37 patients with suspected infective endocarditis, 29 of whom had surgery for definite disease.

CT correctly identified 28 of 29 patients with valve abnormalities identified by TEE and correctly classified 70 of 73 valves to have abnormalities indicating infective endocarditis or not, the authors report.

Similarly, CT correctly identified 26 of 27 patients with intraoperatively proven vegetations and correctly classified 55 of 57 valves to be either affected by vegetations or not.

CT correctly diagnosed two vegetations on a mechanical prosthesis that were missed by TEE because of metal artifacts.

CT was superior to TEE for showing perivalvular involvement of abscesses and pseudoaneurysms in three patients, the researchers note, but none of the four intraoperatively confirmed mitral valve leaflet perforations detected by TEE were visualized by CT.

"If a patient is referred to chest CT anyway to look for sources of inflammation/sepsis, one may consider performing a combined chest/cardiac gated CT scan," Feuchtner said. "However, we believe that the main role of CT currently is not as primary tool, but to offer comprehensive information, e.g., to clarify (various) issues after an initial TEE."

Feuchtner pointed out that the costs are approximately 300 euros for a CT and 250 euros for TEE.

By Will Boggs, M.D.

J Am Coll Cardiol 2009;53:436-444.

Last Updated: 2009-02-12 12:27:41 -0400 (Reuters Health)

Related Reading

Prompt removal necessary to treat cardiac device-related infective endocarditis, February 5, 2008

Copyright © 2009 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

Page 1 of 1235
Next Page