Abstract
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Objectives Diagnosis of infected cardiovascular prostheses (CVP) in patients (pts) with long-standing fever is difficult and management (surgical vs. medical) of these pts in serious condition is challenging. We assessed the value of FDG PET/CT in detection and localization of infected CVP and its impact on treatment.
Methods 14 pts with CVP (7 with a pacemaker, vascular graft (4), pulmonary stent (2), mitral valve prosthesis (1)) presented with longstanding fever. All received a conventional treatment of 6 weeks of antibiotics (AB) and underwent repeated bacteriologic work-up, trans-thoracic/trans-esophageal echocardiogram (Echo) and IV contrast CT. PET/CT was performed at initiation of treatment and was compared with the other modalities and clinical follow-up.
Results 8/14 pts had bacteremia. 5 pts (pacemaker (3), vascular graft (1) and pulmonary stent (1)) with initial positive PET/CT (+) on CVP showed no response to AB and underwent surgery that confirmed infection. In the 9 pts who responded to AB, initial PET/CT was negative (-) in 4 pts (pacemaker (3), mitral prosthesis (1)) and (+) in 5 (pacemaker (1), vascular graft (3), pulmonary stent (1)). 12 pts returned to normal, 1 died during surgery and 1 of unrelated cause.
Conclusions In this small series, PET/CT was useful in detecting and localizing CVP infection and therefore contributes to appropriately select surgical candidates. As in other infections a negative PET/CT seems to be a good prognostic factor. Correlation of clinical, Echo and PET/CT findings is crucial for the therapeutic decision in these complex pts
Clinical and imaging findings in pts with suspected infected CVP
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