Multimodality imaging – ABC CARDIOL

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Research Letter

Infective Endocarditis: A Never-Ending Ordeal?

Catarina Gregório et al. Ana Beatriz Garcia Susana Gonçalves Nuno Guerra … Fausto J. Pinto Catarina Sousa

Introduction

Prosthetic valve endocarditis (PVE) is an uncommon but life-threatening condition. This report describes a challenging case of recurrent PVE with paravalvular complications requiring multiple surgical interventions.

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Prosthetic Aortic Valve Endocarditis by Neisseria Elongata after Bentall Procedure: When Multimodality Imaging is Key to Diagnosis

Mariana Brandão et al. Pedro Gonçalves-Teixeira Pedro Ribeiro Queirós Nuno Dias Ferreira Marco Oliveira

A diabetic 65-year-old male with previous Bentall procedure and mechanical aortic valve prosthesis presented with fever and abdominal pain, along with systolic murmur (III/VI) and elevated inflammatory markers. Abdominal computed tomography (CT) revealed splenic infarction. Transesophageal echocardiogram (TEE) was negative for vegetations. Given the persistent suspicion of infective endocarditis (IE) with peripheral embolism, empirical antimicrobial therapy was initiated. The patient subsequently presented with complete atrioventricular block, requiring temporary transvenous pacing. An epicardial pacemaker was later implanted.

At the time, cardiac CT revealed an irregular-shaped hypoattenuating mass attached to the ventricular side of the prosthetic suture ring, consistent with vegetation (), interfering with the normal opening of one of the prosthesis discs (). Repeat TEE also showed a small highly mobile vegetation and an annular abscess in the prosthetic aortic valve (). Blood cultures were positive for Neisseria elongata, confirming the diagnosis of prosthetic valve endocarditis (PVE); antimicrobial therapy was tailored. Despite early improvement, the patient later presented with de novo ataxia and brain CT revealed infarction in the right vertebrobasilar territory. New sets of cultures remained negative and coagulation levels were within therapeutic range. A small vegetation persisted on cardiac CT and TEE, and inflammatory infiltrate was apparent at the mitro-aortic curtain.

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Case Report

A Case of Acute Myocardial Infarction and Pericarditis Unmasking Metastatic Involvement of the Heart

Sofia Torres et al. Mariana Vasconcelos Carla Sousa Antonio J. Madureira … Alzira Nunes Maria Júlia Maciel

Introduction

Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis.^, While they are most commonly asymptomatic, cardiac metastases can mimic primary cardiac diseases such as acute coronary syndromes, congestive heart failure and pericarditis.^, Lung cancer is the most frequent source of metastatic cardiac disease, either from direct extension or by a combination of lymphatic, hematogenous, and transvenous dissemination.^,

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Infective Endocarditis: A Never-Ending Ordeal?

Introduction

Prosthetic Aortic Valve Endocarditis by Neisseria Elongata after Bentall Procedure: When Multimodality Imaging is Key to Diagnosis

A Case of Acute Myocardial Infarction and Pericarditis Unmasking Metastatic Involvement of the Heart

Introduction

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