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Archives of cardiovascular diseases
Volume 106, n° 1
pages 52-62 (janvier 2013)
Doi : 10.1016/j.acvd.2012.09.004
Received : 11 July 2012 ;  accepted : 17 September 2012
Imaging investigations in infective endocarditis: Current approach and perspectives
Imagerie de l’endocardite infectieuse : approche actuelle et perspectives

Figure 1

Figure 1 : 

Indications for echocardiography in the diagnosis and assessment of infective endocarditis. IE: infective endocarditis; TTE: transthoracic echocardiography; TEE: transoesophageal echocardiography.

Figure 2

Figure 2 : 

Mitroaortic infective endocarditis explored by two-dimensional (2D) and three-dimensional (3D) transoesophageal echocardiography (TEE). The 2D TEE (A) shows destruction of the cusps of the aortic valve with vegetations (white arrow) and perforation of the basal portion of the anterior leaflet (red arrow), resulting in severe mitral regurgitation visualized by colour Doppler (B). The 3D TEE allows better localization of the mitral perforation thanks to an atrial ‘en face’ view (C) and a left ventricle view (D).

Figure 3

Figure 3 : 

Cardiac and cerebral computed tomography (CT) scan in a patient with a mitroaortic infective endocarditis. This figure illustrates that the CT scan allows rapid and accurate assessment of structural cardiac damage and extracardiac complications. The electrocardiogram-gated cardiac CT scan (A) shows a calcified aortic valve with a large pseudoaneurysm just below the ostium of the left coronary artery (green arrow) and an ‘aneurysm’ of the mitral valve anterior leaflet (red arrow). The cerebral CT scan (B) shows, after contrast injection, the suspicion of a mycotic (infectious) aneurysm of the right middle cerebral artery (orange arrow), which was confirmed by three-dimensional reconstruction of the angiography (C,D).

Figure 4

Figure 4 : 

Results of echocardiographic studies and 18F-fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG PET/CT) in a case of suspicion of aortic bioprosthetic valve infective endocarditis. The first transoesophageal echocardiography (TEE) (A) showed a small doubtful thickening around the aortic bioprosthetic annulus (yellow arrow) in a patient with fever and negative blood cultures. The second TEE (B), performed 8days later, showed the development of a periprosthetic abscess (yellow arrow). 18F-FDG PET/CT performed the day after the first TEE showed hyperfixation around the aortic prosthesis (C). The patient underwent urgent valve surgery, which confirmed the abscess. Of note, colonic hyperfixation was shown by 18F-FDG PET/CT (green arrow), which allowed a polyp to be revealed at the colonoscopy performed thereafter.

Figure 5

Figure 5 : 

Imaging perspectives for improvement of the management of infective endocarditis (IE). 2D: two-dimensional; 3D: three-dimensional; CT: computed tomography; MRI: magnetic resonance imaging; PET: positron emission tomography; TEE: transoesophageal echocardiography; TTE: transthoracic echocardiography.

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