Key result
Multidisciplinary imaging review identifies remnant BioGlue mimicking aortic root abscess, safely avoiding re-do surgery.
Why the study?
Post-operative changes can cause false-positive findings on echocardiography and cardiac PET when evaluating suspected prosthetic valve endocarditis.
Case Report (n=1)
No
Thorough multi-disciplinary review of prior surgical history (such as BioGlue use) and serial multi-modality imaging is critical to distinguish non-infectious post-operative mimics from true para-valvular abscesses, thereby avoiding unnecessary high-risk re-do cardiac surgery.
Consideration of surgical materials in post-op imaging differentials may avert unnecessary re-do surgery; extends case-based evidence on aortic mimics.
Background: While echocardiography and cardiac positron emission tomography (PET) can aid in the diagnosis of prosthetic valve endocarditis (PVE), post-operative changes can lead to false-positive imaging findings. We report a case of a patient with an aortic valve prosthesis with remnant BioGlue deposits mimicking a para-valvular abscess on imaging in the setting of suspected PVE. Case summary: . Initial transoesophageal echocardiogram (TEE) was notable for a thickening of the posterior aortic root thought to be consistent with post-surgical changes. Cardiac PET showed significant uptake around the prosthetic aortic valve, concerning for a para-valvular abscess. However, given the patient's high risk for re-do surgery, clearance of blood cultures, and preserved valve function, our multi-disciplinary endocarditis team (MET) recommended non-surgical management and close follow-up. After 6 weeks of appropriate antibiotics, a TEE demonstrated concern for an evolving para-valvular abscess. The MET performed extensive review of his prior surgical interventions and cardiac imaging, revealing the previous use of surgical BioGlue and stability in the aortic root on imaging, consistent with non-infectious post-surgical changes, and conservative management was recommended. Discussion: Thorough review of prior interventions and serial imaging in patients with suspected PVE through a multi-disciplinary team approach is essential in elucidating the complete, often complex, clinical picture and recommending the most appropriate management.
No takes yet. Share an insight, caveat, or question.
Cáceres et al. (2025) conducted a case report in Suspected prosthetic valve endocarditis (PVE) with remnant surgical BioGlue deposits mimicking a para-valvular abscess (n=1). Multi-disciplinary endocarditis team (MET) imaging review, pacemaker extraction, and conservative medical management (cefepime and suppressive levofloxacin) was evaluated on Resolution of infection and avoidance of high-risk re-do aortic root surgery at 12-month follow-up. Multi-disciplinary review of serial imaging identified remnant BioGlue mimicking an aortic root abscess in a 67-year-old man, avoiding re-do surgery with no infection recurrence at 12 months.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: