Preoperative evaluation in aortic endocarditis: findings on cardiac CT.
OBJECTIVE
The purpose of this study was to study the feasibility and diagnostic capability of preoperative cardiac CT for depicting aortic valvular pseudoaneurysms and vegetations in patients referred for aortic endocarditis requiring surgical intervention.


METHODS
Consecutive patients presenting with active aortic endocarditis requiring surgical intervention were included. CT scan examinations were performed for assessing coronary artery status. Aortic valves were retrospectively analyzed. Contrast-enhanced CT scans were retrospectively gated to the ECG and obtained without the administration of a beta-blocker. The CT and intraoperative findings were systematically compared.


RESULTS
During a 4-year period, 19 consecutive patients (18 men and one woman) were included (mean age +/- SD, 55 +/- 13 years). Results are expressed on a per-patient basis. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in depicting aortic valve pseudoaneurysms were 100%, 87.5%, 91.7%, and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the MDCT in depicting the extension of the aortic valve pseudoaneurysms into the intervalvular fibrous body were each 100%. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in depicting aortic valve vegetations were 71.4%, 100%, 100%, and 55.5%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT for depicting aortic valve vegetations larger than 1 cm were all 100%.


CONCLUSIONS
Our study shows the feasibility of preoperative CT in aortic infective endocarditis for providing relevant data about the presence and relationships of aortic valvular pseudoaneurysms. A larger prospective study including a systematic comparison with transesophageal echocardiography should be performed to determine the respective value of each technique.
Gahide
Gérald
G
Radiologie Centrale, Hôpital Arnaud de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, 371 Avenue du Doyen Gaston Giraud, 34000 Montpellier, France. geraldgahide@hotmail.com
Bommart
Sebastien
S
Demaria
Roland
R
Sportouch
Catherine
C
Dambia
Hilaire
H
Albat
Bernard
B
Vernhet-Kovacsik
Hélène
H
D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D003287:Contrast Media; D004562:Electrocardiography; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007479:Iopamidol / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011857:Radiographic Image Interpretation, Computer-Assisted; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; C057937:iomeprol; D007479:Iopamidol