Please use this identifier to cite or link to this item:
https://repository.monashhealth.org/monashhealthjspui/handle/1/27222
Title: | The role of four-dimensional computed tomography in transcatheter aortic valve replacement prosthesis endocarditis with concurrent leaflet thrombosis: A case report. | Authors: | Brown A.J.;Khav N.;Rashid H.N. | Institution: | (Khav, Rashid, Brown) Monash Cardiovascular Research Centre and Monash Heart, Monash Health, 246 Clayton Road, Clayton, VIC 3168, Australia | Issue Date: | 24-Feb-2021 | Copyright year: | 2021 | Publisher: | Oxford University Press | Place of publication: | United Kingdom | Publication information: | European Heart Journal - Case Reports. 4 (5) (no pagination), 2021. Article Number: ytaa252. Date of Publication: 2021. | Journal: | European Heart Journal - Case Reports | 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 fourdimensional computed tomography provides further evaluation of prosthesis leaflet morphology/motion, providing valuable diagnostic information.Copyright © The Author(s) 2020. | DOI: | http://monash.idm.oclc.org/login?url= http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1093/EHJCR/YTAA252 |
ISSN: | 2514-2119 (electronic) | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/27222 | Type: | Article | Subjects: | clinical article comorbidity coronary stenting drug substitution drug withdrawal Enterococcus faecium geriatric patient Gram positive cocci high risk patient human hypertension/dt [Drug Therapy] infection/dt [Drug Therapy] male medical history neutrophilia *prosthetic valve endocarditis/co [Complication] *prosthetic valve endocarditis/di [Diagnosis] *prosthetic valve endocarditis/dt [Drug Therapy] prosthetic valve thrombosis/co [Complication] prosthetic valve thrombosis/di [Diagnosis] systolic heart murmur thorax radiography thrombosis/di [Diagnosis] thrombosis/dt [Drug Therapy] *transcatheter aortic valve implantation transesophageal echocardiography transthoracic echocardiography treatment response very elderly ampicillin/dt [Drug Therapy] ampicillin/iv [Intravenous Drug Administration] ampicillin/pv [Special Situation for Pharmacovigilance] antibiotic agent/dt [Drug Therapy] antibiotic agent/pv [Special Situation for Pharmacovigilance] anticoagulant agent/dt [Drug Therapy] anticoagulant agent/pv [Special Situation for Pharmacovigilance] bisoprolol/dt [Drug Therapy] bisoprolol/pv [Special Situation for Pharmacovigilance] C reactive protein/ec [Endogenous Compound] gentamicin/dt [Drug Therapy] gentamicin/iv [Intravenous Drug Administration] gentamicin/pv [Special Situation for Pharmacovigilance] irbesartan/dt [Drug Therapy] irbesartan/pv [Special Situation for Pharmacovigilance] rivaroxaban/dt [Drug Therapy] rivaroxaban/pv [Special Situation for Pharmacovigilance] vancomycin/dt [Drug Therapy] vancomycin/iv [Intravenous Drug Administration] warfarin/dt [Drug Therapy] warfarin/pv [Special Situation for Pharmacovigilance] computed tomography scanner *percutaneous aortic valve/am [Adverse Device Effect] *prosthesis leaflet thrombosis/co [Complication] *prosthesis leaflet thrombosis/di [Diagnosis] *prosthesis leaflet thrombosis/dt [Drug Therapy] *four dimensional computed tomography aged antibiotic therapy anticoagulant therapy *aortic stenosis/su [Surgery] *aortic stenosis/th [Therapy] article artifact atrial fibrillation bacteremia bacterial endocarditis/di [Diagnosis] bacterial endocarditis/dt [Drug Therapy] blood culture case report cerebrovascular accident blood culture case report cerebrovascular accident clinical article antibiotic therapy coronary stenting drug substitution drug withdrawal Enterococcus faecium *four dimensional computed tomography geriatric patient Gram positive cocci high risk patient human hypertension / drug therapy infection / drug therapy male medical history neutrophilia *prosthetic valve endocarditis / *complication / *diagnosis / *drug therapy prosthetic valve thrombosis / complication / diagnosis systolic heart murmur thorax radiography thrombosis / diagnosis / drug therapy *transcatheter aortic valve implantation transesophageal echocardiography transthoracic echocardiography treatment response very elderly aged comorbidity anticoagulant therapy *aortic stenosis / *surgery / *therapy Article artifact atrial fibrillation bacteremia bacterial endocarditis / diagnosis / drug therapy |
Type of Clinical Study or Trial: | Case series or case report |
Appears in Collections: | Articles |
Show full item record
Items in Monash Health Research Repository are protected by copyright, with all rights reserved, unless otherwise indicated.