AJR:194, March 2010
Gerald Gahide, Sebastien Bommart, Roland Demaria, Catherine Sportouch, Hilaire Dambia, Bernard Albat, Helene Vernhet-Kovacsik
OBJECTIVE. The purpose of this study was to study the feasibility and diagnostic capa¬bility of preoperative cardiac CT for depicting aortic valvular pseudoaneurysms and vegeta¬tions in patients referred for aortic endocarditis requiring surgical intervention.
MATERIALS AND METHODS. Consecutive patients presenting with active aortic endo¬carditis 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 ß-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 sensi¬tivity, 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 sensitiv¬ity, specificity, positive predictive value, and negative predictive value of the MDCT in depict¬ing 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%, respective¬ly. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT for depicting aortic valve vegetations larger than 1 cm were all 100%.
CONCLUSION. Our study shows the feasibility of preoperative CT in aortic infective endo¬carditis for providing relevant data about the presence and relationships of aortic valvular pseudo¬aneurysms. A larger prospective study including a systematic comparison with transesophageal echocardiography should be performed to determine the respective value of each technique.