Improving the Diagnostic Performance of Prosthetic Heart Valve Endocarditis

More than 300.000 prosthetic heart valves are implanted worldwide every year. An intricate disease with a tremendous 1-year mortality of up to 50% affects patients with such a valve at a rate of 1-2% per patient per year after implantation: prosthetic heart valve endocarditis, an infection of the valve or surrounding tissues. The diagnosis of this complication remains difficult, as blood cultures are often false negative and echocardiographic imaging of prosthetic heart valves is limited by the acoustic shadowing of their metallic components. 18-Fluorine Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET) is a technique most commonly used in oncology, which employs radioactively labeled glucose analogues to depict the most metabolically active cells in the body. As an immune response to an infection is highly active, we explored the use of this technique in the (early) detection of prosthetic heart valve endocarditis and evaluated its limitations. In this thesis, the value and limitations of 18F-FDG PET and cardiac Computed Tomography Angiography (CTA) in the assessment of suspected prosthetic heart valve endocarditis are explored, as well as potential patient-, technique- and interpretation-related factors that may hamper a correct diagnosis.

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