Utility PET/CT for identifying Prosthetic valve endocarditis in pediatric patients and correlating with outcomes

Utility PET/CT for identifying Prosthetic valve endocarditis in pediatric patients and correlating with outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Utility PET/CT for identifying Prosthetic valve endocarditis in pediatric patients and correlating with outcomes Gladys M. Arguello Fletes, Zachary T. Trenbeath, Kari L. Hayes, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4735687/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Pediatric patients with a history of vascular stents or prosthetic valve replacement face an increased risk of infective endocarditis. Echocardiography and cardiac CT can be limited in some cases for diagnosing prosthetic valve endocarditis. PET/CT has shown promise for diagnosis in difficult cases in adults. We reviewed our clinical experience over 13 years and compared surgical findings and clinical outcomes. Utilizing PET/CT as a diagnostic test for prosthetic valve endocarditis in our study resulted in a positive predictive value of 87.5%, a negative predictive value 100% and an accuracy of 92.3%. Prosthetic valve endocarditis pediatric prosthetic valve infection congenital heart disease PET/CT infective endocarditis Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction The introduction of prosthetic valve s grafts has revolutionized the management of vascular disease but graft infection , although uncommon, remains a dreaded complication associated with significant morbidity and mortality. Infective endocarditis (IE) has a relatively low incidence in children, 0.43-0.69 cases per 100000 children, with risk increasing with congenital heart disease (CHD) and in patients less than 3 years of age in the first six months following surgery for CHD [5]. Dardari et al reported 4% admissions for infected endocarditis in a tertiary facility with 7% mortality . [5] . Prosthetic valves are associated with increased incidence of endocarditis and have inherent limitations in imaging evaluation with traditional imaging as stated before [6, 12,13]. Prosthetic valve endocarditis (PVE) accounts for 20-30% of all cases of IE, increasing over recent decades with advances in both surgical techniques and transcatheter procedures resulting in larger numbers of prosthetic valve replacements[5,12] . The highest incidence based on location of PVE is in the pulmonary position with up to 54% of pulmonary IE being in prosthetic valves in one series [11] Echocardiography is the mainstay of imaging for IE, with transthoracic echocardiography (TTE) having a published sensitivity of TTE for PVE in adults with prosthetic valves of 36-69% [6,12]. Transesophageal echocardiography (TEE) has a higher sensitivity and specificity than TTE but can be limited for patients with prosthetic valves and conduits, particularly in the pulmonary position which often requires sedation or general anesthesia in children [5,12] . Magnetic Resonance imaging for PVE has significant limitations including artifact limiting visualization of prosthetic valves or stents as well as artifact from adjacent surgical clips and vascular coils, leading to difficulty in diagnosing infection or complications of PVE . [1,12] . Cardiac CT is widely used in pediatric CHD patients and can often visualize prosthetic valves and adjacent tissues with meticulous technique as well as evaluate for paravalvular extension of infection which is seenin nearly 50% of cases [5,12]. Cardiac CT can be limited in some patients by significant artifact, and it can be difficult to determine if a finding adjacent to prosthetic material indicates infected material or other postsurgical or interventional changes and endothelialization. PET/CT with 18F-Fluordesoxyglucose (FDG-PET) is widely used in oncology and has utility for infectious diseases in localizing source or focus of infection. PET/CT has been shown to be useful for vascular prothesis infections in adults, with a small number of pediatric patients studied in a larger cohort by Meyers et al and 1 case report by Chau et al [13, 11]. This paper evaluates the accuracy and utility of PET/CT to identify post vascular prosthesis infections and influence early management decisions in the pediatric population. Methods And Materials The study, approved by the Institutional Review Board (IRB), focused on patients up to 25 years of age with a history of valvular prostheses. Electronic medical record search was performed for patients undergoing PET/CT between January 1, 2010, and January 30, 2024, with clinical signs of infection including fever of unknown origin, bacteremia and having implanted cardiac vascular prosthetic material. Data collected includes patient demographics, type of congenital heart disease, prior surgical history and cardiac catheterization procedures and presence of vascular stents, prosthetic valves and other implanted material such as vascular conduits , as well as laboratory values including blood cultures, hospitalization, subsequent surgeries for prosthetic material removal, if performed , as well as clinical follow up and antibiotic therapy. Scan preparation For better assessment of the myocardium and adjacent vessels, patients underwent high-fat, low-carbohydrate (ketogenic) diet for 24 hours prior to PET/CT imaging had been performed to suppress the physiologic FDG uptake in the myocardium. This was important to better assess true infection associated with adjacent vasculature, such as aortic or pulmonary valve prosthesis. Before undergoing PET/CT, all patients also fasted for 12 hours prior to injection. One of the patients was a type I diabetic patient that required specific glucose management from the endocrinology service, with adequate glucose control and myocardial nulling. Proper myocardial nulling is shown in Figure 1. Additional instructions for 24 h prior to PET/CT include avoiding exercise and limiting activities like texting and video games to decrease muscular uptake on scan. PET/CT technique Injection of 18-fluorodeoxyglucose (FDG) radiotracer was performed manually and then patient was placed in a quiet dark room for 40-60min prior to scan with warm blankets. Scans were performed on Siemens Somatom from Jan 2010-2020 and from 2020 to present on Siemens Biograph Edge. PET images were acquired in 2 ranges for a whole body at a scan speed of 1.1cm/sec head to femur then 2.2cm/sec for the lower extremities. CT images were acquired in the same setting and used for anatomic localization and attenuation correction and were fused with PET images on Syngovia and sent to PACS. Imaging analysis All PET/CT studies were reviewed by experienced pediatric radiologists with subspecialty expertise in nuclear imaging. Studies were assessed for adequate myocardial nulling and were considered adequate if FDG uptake in the myocardium was less than blood pool. A study was considered positive for infected prosthesis with appropriate pattern of uptake and SUV values of greater than 3.0 at the site of prosthesis. Scans were also reviewed for other sites of potential infection which could be the source of underlying infection. In addition, any relevant cross sectional imaging including echocardiography and cardiac CT obtained in the acute setting for evaluation of possible source of infection were reviewed and findings were correlated with PET/CT as well as surgical and clinical outcomes. Imaging results were correlated with surgical reports performed for removal of prosthetic material. For patients who did not undergo surgery, outcomes were assessed through clinical follow up in the electronic medical record . Results Thirteen patients with a history of cardiovascular surgery underwent PET imaging for suspected vascular prosthesis infection. Patient demographics are summarized in table 1. Out of the 13 patients, 8 (61.5 %) had positive PET/CT findings for vascular prosthetic infection, while 5(38.4%) were negative and diagnosed with fever from endocrine and gastrointestinal causes. Those with negative results did not undergo surgery and were clinically followed , with subsequent resolution of fever and infection. Among the 8 patients with positive PET/CT results, all had prior imaging studies. Two patients had negative echocardiograms and cardiac CT scans, two had indeterminate findings, and three showed positive endocarditis on studies prior to PET/CT. One patient had no imaging prior to PET/CT. Of those patients with positive PVE, the most common were in the pulmonary position including right ventricle to pulmonary artery conduit and prosthetic pulmonary valve. This is summarized in table 2. Figure 2 demonstrates infected aortic stent in patient with aortic stent for interrupted aortic arch. One of the eight patients (12.5%) that had positive PET/CT had recent surgery for infected prosthesis removal and placement of new prosthetic valve surgery two weeks prior to PET/CT. This patient was treated with antibiotic therapy and no additional surgery was performed. This positive uptake may have been secondary to healing changes from recent surgery or residual infection. Four of the eight patients with positive results had a good clinical outcome (50%), while three experienced surgical-related complications and recurrent infections (37.5%). Figure 3 demonstrates a patient with LVOT graft and RVPA conduit, both with increased FDG uptake. Notably, one patient underwent PET/CT at two different time points, both confirming vascular prosthesis-related infection. Of the four patients that had PET/CT negative for infected prosthesis, all were followed clinically with resolution of infection. Most patients tolerated ketogenic diet and fasting without difficulty. We had one patient with known Type 1 diabetes complicated by moderate Diabetic ketoacidosis that resolved during hospitalization and was managed by endocrinology, causing initial ly planned PET/CT to be delayed while optimizing blood glucose levels. Endocrinology continued manual mode with his insulin pump until transitioning with BG <200 until PET scan with close monitoring. He continued blood glucose correction and carbohydrate coverage via pump correcting his hyperglycemia exactly 4 hours prior to PET/CT scan. The myocardial nulling was adequate with a fasting glucose level of 124mg/dL for the scan, and the patient had no complications. Positive and negative predictive value and accuracy of PET/CT to detect infection in cardiovascular prosthesis was calculated using surgery and clinical management as the gold standard. Figure 4 demonstrates a patient with two prosthetic valves, only one with increased FDG uptake. Outcomes included seven true positive patients, five true negative patients and one false positive patient. This results in a positive predictive value of 87.5%, negative predictive value 100% , and an accuracy of 92.3%. Discussion Our study shows promise for utilization of PET/CT for diagnosing PVE and conduit IE with high accuracy and positive and negative predictive value compared to gold standards of surgery and clinical follow up and is aided by use of ketogenic diet to null signal of myocardium uptake. PET/CT shows promise when there is high clinical suspicion and evaluation is limited with other imaging modalities for PVE. Our findings correlate with the case report by Chau et al of suspected PVE which was confirmed on PET/CT [11]. Our findings also correlate with the findings of a subset in a larger series by Meyers et al [13]. While their study had a wider focus of PET/CT use for other indications, one part of their study was for IE in CHD patients with 4/13 pediatric patients in the CHD cohort for IE , with prosthetic valves or conduits. They concluded that PET/CT played a useful role in diagnosis of PVE (Meyers). Imaging, specifically PET/CT , can help confirm IE with high sensitivity but also evaluate the extent of infection. In the adult congenital heart disease population with infected cardiovascular prosthesis PET/CT has been shown to be helpful in making diagnosis of PVE with a positive predictive value of 94 % and a negative predictive value of 84% as concluded by Pizzi et al [9] . This was similar to our results with a positive predictive value of 87.5% and a negative predictive value of 100%. The largest published study in adults is a meta-analysis of 537 patients undergoing PET/CT for PVE evaluation with sensitivity of 85% and specificity 86.5%, when those called possible PVE were counted as positive [14]. Limitations of our study include small size patient cohort and a retrospective review at a single institution. Limitations of obtaining PET/CT in the early postoperative setting can lead to false positive results with reparative inflammatory processes also having uptake of the radiopharmaceutical in the surgery bed. Larger volume studies and/or a multi-institutional study may be helpful to further evaluate this imaging technique for PVE. Conclusion This study concludes that PET/CT shows promise to accurately identify post vascular prosthesis infection in pediatric patients. When performed in the appropriate clinical setting, PET/CT aids in early management decisions and helps guide management. Additionally, the high accuracy and negative predictive value of PET/CT allows for the exclusion of PVE reducing the need for unnecessary surgery. This research underscores the importance of incorporating PET/CT into the diagnostic algorithm for pediatric patients with suspected vascular prosthesis infections, ultimately contributing to enhanced patient care. Declarations The authors have no relevant financial or non-financial interests to disclose. References Minamimoto R. Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT. Jpn J Radiol. 2021 Jun;39(6):540-557. doi: 10.1007/s11604-021-01097-6. Epub 2021 Jan 31. PMID: 33517516; PMCID: PMC8175248. Vigil Díaz C, Salvat Dávila C, Fernández Llana B, Domínguez Grande ML, Suárez Fernández JP, Martín Fernández N, et al. PET/TC con 18FFluordesoxiglucosa en pacientes con sospecha de infección de prótesis endovasculares. Rev Esp Med Nucl Imagen Mol. 2021;40:12–18 Asbjørn Mathias Scholtens, Laurens E. Swart, Hein Jan Verberne, Wilco Tanis, Marnix G.E.H. Lam, Ricardo P.J. Budde,Confounders in FDG-PET/CT Imaging of Suspected Prosthetic Valve Endocarditis,JACC: Cardiovascular Imaging,Volume 9, Issue 12,2016,Pages 1462-1465,ISSN 1936-878X,https://doi.org/10.1016/j.jcmg.2016.01.024. Kubota K, Nakamoto Y, Tamaki N, Kanegae K, Fukuda H, Kaneda T, Kitajima K, Tateishi U, Morooka M, Ito K, Minamimoto R, Murakami K. FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study. Ann Nucl Med. 2011 Jun;25(5):355-64. doi: 10.1007/s12149-011-0470-6. Epub 2011 Feb 23. PMID: 21344168. Dardari M, Cinteza E, Vasile CM, Padovani P, Vatasescu R. Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies. J Clin Med. 2023 Jul 27;12(15):4941. doi: 10.3390/jcm12154941. PMID: 37568344; PMCID: PMC10420327. Li W, Somerville J. Infective endocarditis in the grown-up congenital heart (GUCH) population. Eur Heart J. 1998 Jan;19(1):166-73. doi: 10.1053/euhj.1997.0821. PMID: 9503191. Cahill TJ, Raby J, Jewell PD, Brennan PF, Banning AP, Byrne J, Kharbanda RK, MacCarthy PA, Thornhill MH, Sandoe JAT, Spence MS, Ludman P, Hildick-Smith DJR, Redwood SR, Prendergast BD. Risk of infective endocarditis after surgical and transcatheter aortic valve replacement. Heart. 2022 Apr;108(8):639-647. doi: 10.1136/heartjnl-2021-320080. Epub 2022 Jan 20. PMID: 35058295. Pizzi MN, Roque A, Fernández-Hidalgo N, Cuéllar-Calabria H, Ferreira-González I, Gonzàlez-Alujas MT, Oristrell G, Gracia-Sánchez L, González JJ, Rodríguez-Palomares J, Galiñanes M, Maisterra-Santos O, Garcia-Dorado D, Castell-Conesa J, Almirante B, Aguadé-Bruix S, Tornos P. Improving the Diagnosis of Infective Endocarditis in Prosthetic Valves and Intracardiac Devices With 18F-Fluordeoxyglucose Positron Emission Tomography/Computed Tomography Angiography: Initial Results at an Infective Endocarditis Referral Center. Circulation. 2015 Sep 22;132(12):1113-26. doi: 10.1161/CIRCULATIONAHA.115.015316. Epub 2015 Aug 14. PMID: 26276890. Soria Jiménez CE, Papolos AI, Kenigsberg BB, Ben-Dor I, Satler LF, Waksman R, Cohen JE, Rogers T. Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2023 May 30;81(21):2115-2127. doi: 10.1016/j.jacc.2023.03.412. PMID: 37225366. Chau A, Renella P, Arrieta A. Multimodality cardiovascular imaging in the diagnosis and management of prosthetic valve infective endocarditis in children report of two cases and brief review of the literature. Cardiol Young. 2019 Dec;29(12):1526-1529. doi: 10.1017/S1047951119002233. Epub 2019 Oct 8. PMID: 31590699. Horgan SJ, Mediratta A, Gillam LD. Cardiovascular Imaging in Infective Endocarditis: A Multimodality Approach. Circ Cardiovasc Imaging. 2020 Jul;13(7):e008956. doi: 10.1161/CIRCIMAGING.120.008956. Epub 2020 Jul 20. PMID: 32683888. Lo Presti S, Elajami TK, Zmaili M, Reyaldeen R, Xu B. Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review. World J Cardiol. 2021 Aug 26;13(8):254-270. doi: 10.4330/wjc.v13.i8.254. PMID: 34589164; PMCID: PMC8436678 . Meyer Z, Fischer M, Koerfer J, Laser KT, Kececioglu D, Burchert W, Ulrich S, Preuss R, Haas NA. The role of FDG-PET-CT in pediatric cardiac patients and patients with congenital heart defects. Int J Cardiol. 2016 Oct 1;220:656-60. doi: 10.1016/j.ijcard.2016.06.109. Epub 2016 Jun 23. PMID: 27393845. O'Gorman P, Nair L, Kisiel N, Hughes I, Huang K, Hsu CC, Fagman E, Heying R, Pizzi MN, Roque A, Singh K. Meta-analysis assessing the sensitivity and specificity of 18F-FDG PET/CT for the diagnosis of prosthetic valve endocarditis (PVE) using individual patient data (IPD). Am Heart J. 2023 Jul;261:21-34. doi: 10.1016/j.ahj.2023.03.004. Epub 2023 Mar 18. PMID: 36934977. Tables Table 1 Patient Age in years Type of CHD Prior surgery and Prosthetic material PET/CT Site of infection Management 1 24 D-TGA Arterial switch & RV-PA conduit homograft Mechanical aortic valve replacement Melody transcatheter PVR FDG uptake in the RV-PA conduit tract and LVOT RV-PA conduit and Melody valve Excision and replacement of RV-PA conduit and Melody valve 2 15 TOF type DORV Two prior RV-PA conduit placements Sapien transcatheter PVR Avid FDG uptake in the PA stent and surrounding soft tissues. Sapien inside Contegra conduit Replacement of RV-PA conduit, removal of Sapien 3 20 TOF Bioprosthetic pulmonary valve replacement LPA stent placement for stenosis RV-PA conduit Increased FDG uptake wall PA homograft & LPA Bioprosthetic pulmonary valve Surgical replacement of RV-PA conduit 4 5 Truncus arteriosus & hypoplastic pulmonary artery Synergraft RV-PA conduit, MPA, RPA, LPA stent Trifecta bioprosthesis 3 years later FDG uptake pulmonic valve Trifecta pulmonary valve Surgical reconstruction RV-PA homograft conduit 5 8 Pulmonary Atresia with VSD VSD closure & RV to PA conduit Low level uptake at the site of the conduit valve. Contegra conduit Removal of old conduit and replacement of new conduit. IV antibiotics 6 22 Pulmonary Atresia Unifocalization & VSD closure with RV PA conduit. Subsequent conduit replacement New Contegra conduit 2019 Aortic valve replacement Uptake RV-PA conduit & increased FDG uptake within the sternum Contegra Conduit Replacement of RV-PA conduit IV antibiotics 7 13 Interrupted aortic arch Repair of coarctation of aorta & pseudoaneurysm with interposition graft at the site of stent graft FDG uptake around aortic stent Aortic Stent Resection of the infected stent graft, resection of the pseudoaneurysm, interposition graft repair of coarctation of the aorta 8 18 D-TGA Pulmonary valve stenosis Rastelli procedure with RV-PA conduit Uptake in RV-PA Inferior to valve and RV-PA conduit Replacement of RV-PA conduit with homograft & replacement of Rastelli baffle 9 1.5 Heterotaxy DORV Malposed GA BT shunt, biventricular repair, stent in pulmonary veins Negative Gastrointestinal infection Medical 10 23 TOF & Double aortic arch Fontan procedure Tricuspid valve replacement Biventricular pacemaker Negative Sepsis Medical 11 7 Pulmonary atresia & VSD VSD closure RV-PA conduit Negative Pneumonia Medical 12 6 TOF Fontan procedure Negative Pneumonia Medical 13 18 TOF Fontan procedure RVOT cryoablation Negative Non infected thrombus at ICD wire Thrombus removal Table 2 Types of Prosthesis infected Right ventricle to pulmonary artery 4• Aortic to left ventricle baffle 1 Prosthetic pulmonary valve 1 Aortic stent 1 Pulmonary graft allograft 1 •One patient had two prostheses infected, right ventricle to pulmonary artery and aortic to left ventricle baffle Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4735687","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":340551073,"identity":"3a033e8d-1af9-411a-9798-02cbda7139f7","order_by":0,"name":"Gladys M. Arguello Fletes","email":"data:image/png;base64,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","orcid":"","institution":"University of Colorado Denver","correspondingAuthor":true,"prefix":"","firstName":"Gladys","middleName":"M. Arguello","lastName":"Fletes","suffix":""},{"id":340551074,"identity":"478a1bb1-2a5f-4361-afcb-efcd8e73f913","order_by":1,"name":"Zachary T. Trenbeath","email":"","orcid":"","institution":"Children's Hospital Colorado","correspondingAuthor":false,"prefix":"","firstName":"Zachary","middleName":"T.","lastName":"Trenbeath","suffix":""},{"id":340551076,"identity":"226a7d91-6921-41cc-97bb-c9a3f72066ac","order_by":2,"name":"Kari L. Hayes","email":"","orcid":"","institution":"Children's Hospital Colorado","correspondingAuthor":false,"prefix":"","firstName":"Kari","middleName":"L.","lastName":"Hayes","suffix":""},{"id":340551077,"identity":"9d15f21e-bc4c-431e-b0e1-d46a4f5cd4c6","order_by":3,"name":"LaDonna J. Malone","email":"","orcid":"","institution":"Children's Hospital Colorado","correspondingAuthor":false,"prefix":"","firstName":"LaDonna","middleName":"J.","lastName":"Malone","suffix":""}],"badges":[],"createdAt":"2024-07-13 15:11:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4735687/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4735687/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62800094,"identity":"d4b5fdd7-d5d7-4d26-b297-e937c77a61be","added_by":"auto","created_at":"2024-08-19 15:48:15","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":145071,"visible":true,"origin":"","legend":"\u003cp\u003eFused PET/CT axial images showing myocardial nulling and normal physiologic myocardial uptake of FDG. (a) Fused PET/CT axial cropped image shows a proper myocardial nulling with signal in myocardium less than blood pool. (b) Fused PET/CT axial cropped image shows normal physiologic myocardial FDG uptake\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4735687/v1/9dd682b5d26e5c5679499d48.jpg"},{"id":62800095,"identity":"369c9702-5b4b-461e-8bbf-37fcde04a5ec","added_by":"auto","created_at":"2024-08-19 15:48:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":251758,"visible":true,"origin":"","legend":"\u003cp\u003e15-year-old M with history of interrupted aortic arch status post catheter stent placement. (a) 3D volumetric reconstruction of the aorta from CTA with gothic appearance of aortic arch and stent beginning after the left subclavian artery origin. (b and c) Fused PET/CT axial and sagittal reconstructed images with increased FDG uptake surrounding the aortic stent. Note the proper myocardial nulling (black arrowhead)\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4735687/v1/cf5f6b63306a42f2cdf39f63.jpg"},{"id":62800092,"identity":"27c51adc-fc65-4164-96b0-f57c18befb9a","added_by":"auto","created_at":"2024-08-19 15:48:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":295627,"visible":true,"origin":"","legend":"\u003cp\u003e15-year-old M with history of Tetralogy of Fallot status post repair with right ventricle to pulmonary artery conduit (RV-PA) and left ventricle outflow tract (LVOT) graft. (a and b) Axial oblique reconstruction from cardiac CT and fused PET/CT at mid heart level shows the thickening of the RV-PA conduit and increased\u003cu\u003e \u003c/u\u003eFDG uptake (small rectangle) and thickening and calcification of the LVOT graft (circle) and increased FG uptake. (c and d) Sagittal oblique cardiac CT and fused PET/CT show the calcified and thickened RV-PA conduit and LVOT graft with increased FDG uptake both endovascular prostheses\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4735687/v1/310f5191b85276c48ad6cb34.jpg"},{"id":62800962,"identity":"a29f3957-6f4c-4fb3-a078-18f73a4f3327","added_by":"auto","created_at":"2024-08-19 15:56:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":299533,"visible":true,"origin":"","legend":"\u003cp\u003e23-year-old M with history of D-TGA status post arterial switch operation and subsequent PA stent and prosthetic PV as well as prosthetic AV. (a and b) Axial oblique non contrast CT and fused PET/CT at the level of the great arteries showing the aortic valve replacement (arrowhead) and the pulmonary valve replacement (arrow). (c and d) There is increased FDG uptake at the prosthetic pulmonary valve\u003cu\u003e,\u003c/u\u003e higher than blood pool level and similar signal to blood pool level at the aortic valve replacement (arrowhead). Confirmation at surgery of PVE in prosthetic pulmonary valve and no evidence of infection at prosthetic aortic valve. Proper nulling of the myocardium marked with the star\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4735687/v1/8f7688d0d7f4cb7de5b40030.jpg"},{"id":64857425,"identity":"56d32ae2-9ac5-4b7a-9d4b-53ccd5821637","added_by":"auto","created_at":"2024-09-19 15:29:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1322218,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4735687/v1/311de60a-6302-4f31-9f8d-f93b4f37924c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Utility PET/CT for identifying Prosthetic valve endocarditis in pediatric patients and correlating with outcomes","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe introduction of prosthetic valve\u003cs\u003es\u003c/s\u003e grafts has revolutionized the management of vascular disease but graft infection\u003cu\u003e,\u003c/u\u003e although uncommon, remains a dreaded complication associated with significant morbidity and mortality.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInfective endocarditis (IE) has a relatively low incidence in children, 0.43-0.69 cases per 100000 children, with risk increasing with congenital heart disease (CHD) and in patients less than 3 years of age in the first six months following surgery for CHD [5]. Dardari et al reported 4% admissions for infected endocarditis in a tertiary facility with 7% mortality\u003cs\u003e.\u003c/s\u003e [5]\u003cu\u003e.\u003c/u\u003e Prosthetic valves are associated with increased incidence of endocarditis and have inherent limitations in imaging evaluation with traditional imaging as stated before [6, 12,13]. \u0026nbsp;Prosthetic valve endocarditis (PVE) accounts for 20-30% of all cases of IE, increasing over recent decades with advances in both surgical techniques and transcatheter procedures resulting in larger numbers of prosthetic valve replacements[5,12]\u003cu\u003e.\u003c/u\u003e The highest incidence based on location of PVE is in the pulmonary position with up to 54% of pulmonary IE being in prosthetic valves in one series [11] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEchocardiography is the mainstay of imaging for IE, with transthoracic echocardiography (TTE) having\u0026nbsp;\u003cu\u003ea\u0026nbsp;\u003c/u\u003epublished sensitivity of TTE for PVE in adults with prosthetic valves of 36-69% [6,12]. Transesophageal echocardiography (TEE) has a higher sensitivity and specificity than TTE but can be limited for patients with prosthetic valves and conduits, particularly in the pulmonary position which often requires sedation or general anesthesia in children [5,12]\u003cu\u003e.\u003c/u\u003e\u0026nbsp; Magnetic Resonance imaging for PVE has significant limitations including artifact limiting visualization of prosthetic valves or stents as well as artifact from adjacent surgical clips and vascular coils, leading to difficulty in diagnosing infection or complications of PVE\u003cs\u003e.\u003c/s\u003e[1,12]\u003cu\u003e.\u003c/u\u003e\u0026nbsp; Cardiac CT is widely used in pediatric CHD patients and can often visualize prosthetic valves and adjacent tissues with meticulous technique as well as evaluate for paravalvular extension of infection which is seenin nearly 50% of cases [5,12]. Cardiac CT can be limited in some patients by significant artifact, and it can be difficult to determine if a finding adjacent to prosthetic material indicates infected material or other postsurgical or interventional changes and endothelialization. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePET/CT with 18F-Fluordesoxyglucose (FDG-PET) is widely used in oncology and has utility for infectious diseases in localizing source or focus of infection. PET/CT has been shown to be useful for vascular prothesis infections in adults, with a small number of pediatric patients studied in a larger cohort by Meyers et al and 1 case report by Chau et al [13, 11].\u003c/p\u003e\n\u003cp\u003eThis paper evaluates the accuracy and utility of PET/CT to identify post vascular prosthesis infections and influence early management decisions in the pediatric population.\u0026nbsp;\u003c/p\u003e"},{"header":"Methods And Materials","content":"\u003cp\u003eThe study, approved by the Institutional Review Board (IRB), focused on patients up to 25 years of age with a history of valvular prostheses. Electronic medical record search was performed for patients undergoing PET/CT between January 1, 2010, and January 30, 2024, with clinical signs of infection including fever of unknown origin, bacteremia and having implanted cardiac vascular prosthetic material. Data collected includes patient demographics, type of congenital heart disease, prior surgical history and cardiac catheterization procedures and presence of vascular stents, prosthetic valves and other implanted material such as vascular conduits\u003cu\u003e,\u003c/u\u003e as well as laboratory values including blood cultures, hospitalization, subsequent surgeries for prosthetic material removal, if performed\u003cu\u003e,\u003c/u\u003e as well as clinical follow up and antibiotic therapy. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eScan preparation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor better assessment of the myocardium and adjacent vessels, patients underwent high-fat, low-carbohydrate (ketogenic) diet for 24 hours prior to PET/CT imaging had been performed to suppress the physiologic FDG uptake in the myocardium. This was important to better assess true infection associated with adjacent vasculature, such as aortic or pulmonary valve prosthesis. Before undergoing PET/CT, all patients also fasted for 12 hours prior to injection. One of the patients was a type I diabetic patient that required specific glucose management from the endocrinology service, with adequate glucose control and myocardial nulling. Proper myocardial nulling is shown in Figure 1. \u0026nbsp;Additional instructions for 24 h prior to PET/CT include avoiding exercise and limiting activities like texting and video games to decrease muscular uptake on scan. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePET/CT technique\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInjection of 18-fluorodeoxyglucose (FDG) radiotracer was performed manually and then patient was placed in a quiet dark room for 40-60min prior to scan with warm blankets. \u0026nbsp;Scans were performed on Siemens Somatom from Jan 2010-2020 and from 2020 to present on Siemens Biograph Edge. PET images\u003cu\u003e\u0026nbsp;were\u003c/u\u003e acquired in 2 ranges for a whole body at a scan speed of 1.1cm/sec head to femur then 2.2cm/sec for the lower extremities. CT images were acquired in the same setting and used for anatomic localization and attenuation correction and were fused with PET images on Syngovia and sent to PACS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImaging analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll PET/CT studies were reviewed by experienced pediatric radiologists with subspecialty expertise in nuclear imaging. Studies were assessed for adequate myocardial nulling and were considered adequate if FDG uptake in the myocardium was less than blood pool. A study was considered positive for infected prosthesis with appropriate pattern of uptake and SUV values of greater than 3.0 at the site of prosthesis. \u0026nbsp;Scans were also reviewed for other sites of potential infection which could be the source of underlying infection. \u0026nbsp;In addition, any relevant cross sectional imaging including echocardiography and cardiac CT obtained in the acute setting for evaluation of possible source of infection were reviewed and findings were correlated with PET/CT as well as surgical and clinical outcomes. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImaging results were correlated with surgical reports performed for removal of prosthetic material. For patients who did not undergo surgery, outcomes were assessed through clinical follow up in the electronic medical record\u003cu\u003e.\u003c/u\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThirteen patients with a history of cardiovascular surgery underwent PET imaging for suspected vascular prosthesis infection. Patient demographics are summarized in table 1. Out of the 13 patients, 8 (61.5 %) had positive PET/CT findings for vascular prosthetic infection, while 5(38.4%) were negative and diagnosed with fever from endocrine and gastrointestinal causes. Those with negative results did not undergo surgery and were clinically followed\u003cs\u003e,\u003c/s\u003e with subsequent resolution of fever and infection.\u003c/p\u003e\n\u003cp\u003eAmong the 8 patients with positive PET/CT results, all had prior imaging studies. Two patients had negative echocardiograms and cardiac CT scans, two had indeterminate findings, and three showed positive endocarditis on studies prior to PET/CT. One patient had no imaging prior to PET/CT. Of those patients with positive PVE, the most common were in the pulmonary position including right ventricle to pulmonary artery conduit and prosthetic pulmonary valve. This is summarized in table 2. \u0026nbsp;Figure 2 demonstrates infected aortic stent in patient with aortic stent for interrupted aortic arch.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne of the eight patients (12.5%) that had positive PET/CT had recent surgery for infected prosthesis removal and placement of new prosthetic valve surgery two weeks prior to PET/CT. \u0026nbsp;This patient was treated with antibiotic therapy and no additional surgery was performed. This positive uptake may have been secondary to healing changes from recent surgery or residual infection. \u0026nbsp;Four of the eight patients with positive results had a good clinical outcome (50%), while three experienced surgical-related complications and recurrent infections (37.5%). Figure 3 demonstrates a patient with LVOT graft and RVPA conduit, both with increased FDG uptake. Notably, one patient underwent PET/CT at two different time points, both confirming vascular prosthesis-related infection. Of the four patients that had PET/CT negative for infected prosthesis, all were followed clinically with resolution of infection. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost patients tolerated ketogenic diet and fasting without difficulty. \u0026nbsp;We had one patient with known Type 1 diabetes complicated by moderate Diabetic ketoacidosis that resolved during hospitalization and was managed by endocrinology, causing initial\u003cu\u003ely\u003c/u\u003e planned PET/CT to be delayed while optimizing blood glucose levels. Endocrinology continued manual mode with his insulin pump until transitioning with BG \u0026lt;200 until PET scan with close monitoring. He continued blood glucose correction and carbohydrate coverage via pump correcting his hyperglycemia exactly 4 hours prior to PET/CT scan. The myocardial nulling was adequate with a fasting glucose level of 124mg/dL for the scan, and the patient had no complications.\u003c/p\u003e\n\u003cp\u003ePositive and negative predictive value and accuracy of PET/CT to detect infection in cardiovascular prosthesis was calculated using surgery and clinical management as the gold standard.\u0026nbsp;Figure 4 demonstrates a patient with two prosthetic valves, only one with increased FDG uptake.\u0026nbsp;Outcomes included seven true positive patients, five true negative patients and one false positive patient. This results in a positive predictive value of 87.5%, negative predictive value 100%\u003cu\u003e,\u003c/u\u003e and an accuracy of 92.3%.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur study shows promise for utilization of PET/CT for diagnosing PVE and conduit IE with high accuracy and positive and negative predictive value compared to gold standards of surgery and clinical follow up and is aided by use of ketogenic diet to null signal of myocardium uptake. PET/CT shows promise when there is high clinical suspicion and evaluation is limited with other imaging modalities for PVE. Our findings correlate with the case report by Chau et al\u003cu\u003e\u0026nbsp;\u003c/u\u003eof suspected PVE which was confirmed on PET/CT [11]. \u0026nbsp;Our findings also correlate with the findings of a subset in a larger series by Meyers et al [13]. \u0026nbsp;While their study had a wider focus of PET/CT use for other indications, one part of their study was for IE in CHD patients with 4/13 pediatric patients in the CHD cohort for IE\u003cs\u003e,\u003c/s\u003e with prosthetic valves or conduits. \u0026nbsp;They concluded that PET/CT played a useful role in diagnosis of PVE (Meyers). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eImaging, specifically PET/CT\u003cu\u003e,\u003c/u\u003e can help confirm IE with high sensitivity but also evaluate the extent of infection. In the adult congenital heart disease population with infected cardiovascular prosthesis PET/CT has been shown to be helpful in making diagnosis of PVE with a positive predictive value of 94\u003cs\u003e\u0026nbsp;\u003c/s\u003e% and a negative predictive value of 84% as concluded by Pizzi et al [9]\u003cu\u003e.\u003c/u\u003e This was similar to our results with a positive predictive value of 87.5% and a negative predictive value of 100%. The largest published study in adults is a meta-analysis of 537 patients undergoing PET/CT for PVE evaluation with sensitivity of 85% and specificity 86.5%, when those called possible PVE were counted as positive [14].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimitations of our study include small size patient cohort and a retrospective review at a single institution. Limitations of obtaining PET/CT in the early postoperative setting can lead to false positive results with reparative inflammatory processes also having uptake of the radiopharmaceutical in the surgery bed. Larger volume studies and/or a multi-institutional study may be helpful to further evaluate this imaging technique for PVE.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study concludes that PET/CT shows promise to accurately identify post vascular prosthesis infection in pediatric patients. When performed in the appropriate clinical setting, PET/CT aids in early management decisions and helps guide management. Additionally, the high accuracy and negative predictive value of PET/CT allows for the exclusion of PVE reducing the need for unnecessary surgery. This research underscores the importance of incorporating PET/CT into the diagnostic algorithm for pediatric patients with suspected vascular prosthesis infections, ultimately contributing to enhanced patient care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eMinamimoto R. Series of myocardial FDG uptake requiring considerations of myocardial abnormalities in FDG-PET/CT. Jpn J Radiol. 2021 Jun;39(6):540-557. doi: 10.1007/s11604-021-01097-6. Epub 2021 Jan 31. PMID: 33517516; PMCID: PMC8175248.\u003c/li\u003e\n \u003cli\u003eVigil D\u0026iacute;az C, Salvat D\u0026aacute;vila C, Fern\u0026aacute;ndez Llana B, Dom\u0026iacute;nguez Grande ML, Su\u0026aacute;rez Fern\u0026aacute;ndez JP, Mart\u0026iacute;n Fern\u0026aacute;ndez N, et al. PET/TC con 18FFluordesoxiglucosa en pacientes con sospecha de infecci\u0026oacute;n de pr\u0026oacute;tesis endovasculares. Rev Esp Med Nucl Imagen Mol. 2021;40:12\u0026ndash;18\u003c/li\u003e\n \u003cli\u003eAsbj\u0026oslash;rn Mathias Scholtens, Laurens E. Swart, Hein Jan Verberne, Wilco Tanis, Marnix G.E.H. Lam, Ricardo P.J. Budde,Confounders in FDG-PET/CT Imaging of Suspected Prosthetic Valve Endocarditis,JACC: Cardiovascular Imaging,Volume 9, Issue 12,2016,Pages 1462-1465,ISSN 1936-878X,https://doi.org/10.1016/j.jcmg.2016.01.024.\u003c/li\u003e\n \u003cli\u003eKubota K, Nakamoto Y, Tamaki N, Kanegae K, Fukuda H, Kaneda T, Kitajima K, Tateishi U, Morooka M, Ito K, Minamimoto R, Murakami K. FDG-PET for the diagnosis of fever of unknown origin: a Japanese multi-center study. Ann Nucl Med. 2011 Jun;25(5):355-64. doi: 10.1007/s12149-011-0470-6. Epub 2011 Feb 23. PMID: 21344168.\u003c/li\u003e\n \u003cli\u003eDardari M, Cinteza E, Vasile CM, Padovani P, Vatasescu R. Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies. J Clin Med. 2023 Jul 27;12(15):4941. doi: 10.3390/jcm12154941. PMID: 37568344; PMCID: PMC10420327.\u003c/li\u003e\n \u003cli\u003eLi W, Somerville J. Infective endocarditis in the grown-up congenital heart (GUCH) population. Eur Heart J. 1998 Jan;19(1):166-73. doi: 10.1053/euhj.1997.0821. PMID: 9503191.\u003c/li\u003e\n \u003cli\u003eCahill TJ, Raby J, Jewell PD, Brennan PF, Banning AP, Byrne J, Kharbanda RK, MacCarthy PA, Thornhill MH, Sandoe JAT, Spence MS, Ludman P, Hildick-Smith DJR, Redwood SR, Prendergast BD. Risk of infective endocarditis after surgical and transcatheter aortic valve replacement. Heart. 2022 Apr;108(8):639-647. doi: 10.1136/heartjnl-2021-320080. Epub 2022 Jan 20. PMID: 35058295.\u003c/li\u003e\n \u003cli\u003ePizzi MN, Roque A, Fern\u0026aacute;ndez-Hidalgo N, Cu\u0026eacute;llar-Calabria H, Ferreira-Gonz\u0026aacute;lez I, Gonz\u0026agrave;lez-Alujas MT, Oristrell G, Gracia-S\u0026aacute;nchez L, Gonz\u0026aacute;lez JJ, Rodr\u0026iacute;guez-Palomares J, Gali\u0026ntilde;anes M, Maisterra-Santos O, Garcia-Dorado D, Castell-Conesa J, Almirante B, Aguad\u0026eacute;-Bruix S, Tornos P. Improving the Diagnosis of Infective Endocarditis in Prosthetic Valves and Intracardiac Devices With 18F-Fluordeoxyglucose Positron Emission Tomography/Computed Tomography Angiography: Initial Results at an Infective Endocarditis Referral Center. Circulation. 2015 Sep 22;132(12):1113-26. doi: 10.1161/CIRCULATIONAHA.115.015316. Epub 2015 Aug 14. PMID: 26276890.\u003c/li\u003e\n \u003cli\u003eSoria Jim\u0026eacute;nez CE, Papolos AI, Kenigsberg BB, Ben-Dor I, Satler LF, Waksman R, Cohen JE, Rogers T. Management of Mechanical Prosthetic Heart Valve Thrombosis: JACC Review Topic of the Week. J Am Coll Cardiol. 2023 May 30;81(21):2115-2127. doi: 10.1016/j.jacc.2023.03.412. PMID: 37225366.\u003c/li\u003e\n \u003cli\u003eChau A, Renella P, Arrieta A. Multimodality cardiovascular imaging in the diagnosis and management of prosthetic valve infective endocarditis in children report of two cases and brief review of the literature. Cardiol Young. 2019 Dec;29(12):1526-1529. doi: 10.1017/S1047951119002233. Epub 2019 Oct 8. PMID: 31590699.\u003c/li\u003e\n \u003cli\u003eHorgan SJ, Mediratta A, Gillam LD. Cardiovascular Imaging in Infective Endocarditis: A Multimodality Approach. Circ Cardiovasc Imaging. 2020 Jul;13(7):e008956. doi: 10.1161/CIRCIMAGING.120.008956. Epub 2020 Jul 20. PMID: 32683888.\u003c/li\u003e\n \u003cli\u003eLo Presti S, Elajami TK, Zmaili M, Reyaldeen R, Xu B. Multimodality imaging in the diagnosis and management of prosthetic valve endocarditis: A contemporary narrative review. World J Cardiol. 2021 Aug 26;13(8):254-270. doi: 10.4330/wjc.v13.i8.254. PMID: 34589164; PMCID: PMC8436678\u003cu\u003e.\u003c/u\u003e\u003c/li\u003e\n \u003cli\u003eMeyer Z, Fischer M, Koerfer J, Laser KT, Kececioglu D, Burchert W, Ulrich S, Preuss R, Haas NA. The role of FDG-PET-CT in pediatric cardiac patients and patients with congenital heart defects. Int J Cardiol. 2016 Oct 1;220:656-60. doi: 10.1016/j.ijcard.2016.06.109. Epub 2016 Jun 23. PMID: 27393845.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;O\u0026apos;Gorman P, Nair L, Kisiel N, Hughes I, Huang K, Hsu CC, Fagman E, Heying R, Pizzi MN, Roque A, Singh K. Meta-analysis assessing the sensitivity and specificity of 18F-FDG PET/CT for the diagnosis of prosthetic valve endocarditis (PVE) using individual patient data (IPD). Am Heart J. 2023 Jul;261:21-34. doi: 10.1016/j.ahj.2023.03.004. Epub 2023 Mar 18. PMID: 36934977.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eAge in\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eyears\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eType of CHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePrior surgery and Prosthetic material\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePET/CT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eSite of infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eManagement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eD-TGA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eArterial switch \u0026amp; RV-PA conduit homograft\u003c/p\u003e\n \u003cp\u003eMechanical aortic valve replacement\u003c/p\u003e\n \u003cp\u003eMelody transcatheter PVR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eFDG uptake in the RV-PA conduit tract and LVOT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eRV-PA conduit and Melody valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eExcision and replacement of RV-PA conduit and Melody valve\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTOF type DORV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTwo prior RV-PA conduit placements\u003c/p\u003e\n \u003cp\u003eSapien transcatheter PVR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eAvid FDG uptake in the PA stent and surrounding soft tissues.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eSapien inside Contegra conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eReplacement of RV-PA conduit, removal of Sapien\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTOF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eBioprosthetic pulmonary valve replacement\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eLPA stent placement for stenosis \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eRV-PA conduit\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eIncreased FDG uptake wall PA homograft \u0026amp; LPA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eBioprosthetic pulmonary valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical replacement of RV-PA conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTruncus arteriosus \u0026amp; hypoplastic pulmonary artery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eSynergraft RV-PA conduit, MPA, RPA, LPA stent\u003c/p\u003e\n \u003cp\u003eTrifecta bioprosthesis 3 years later\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eFDG uptake pulmonic valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTrifecta pulmonary valve\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eSurgical reconstruction RV-PA homograft conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePulmonary Atresia with VSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eVSD closure \u0026amp; RV to PA conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eLow level uptake at the site of the conduit valve.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eContegra conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eRemoval of old conduit and replacement of new conduit.\u003c/p\u003e\n \u003cp\u003eIV antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePulmonary Atresia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eUnifocalization \u0026amp; VSD closure with RV PA conduit.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eSubsequent conduit replacement\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eNew Contegra conduit 2019\u003c/p\u003e\n \u003cp\u003eAortic valve replacement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eUptake RV-PA conduit \u0026amp; increased FDG uptake within the sternum\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eContegra Conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eReplacement of RV-PA conduit\u003c/p\u003e\n \u003cp\u003eIV antibiotics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eInterrupted aortic arch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eRepair of coarctation of aorta \u0026amp; pseudoaneurysm with interposition graft at the site of stent graft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eFDG uptake around aortic stent\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eAortic Stent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eResection of the infected stent graft, resection of the pseudoaneurysm, interposition graft repair of coarctation of the aorta\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eD-TGA Pulmonary valve stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eRastelli procedure with RV-PA conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eUptake in RV-PA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eInferior to valve and RV-PA conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eReplacement of RV-PA conduit with homograft \u0026amp; replacement of Rastelli baffle\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eHeterotaxy DORV Malposed GA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eBT shunt, biventricular repair, stent in pulmonary veins\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eGastrointestinal infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eMedical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e10\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTOF \u0026amp;\u003c/p\u003e\n \u003cp\u003eDouble aortic arch\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eFontan procedure\u003c/p\u003e\n \u003cp\u003eTricuspid valve replacement\u003c/p\u003e\n \u003cp\u003eBiventricular pacemaker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eSepsis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eMedical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePulmonary atresia \u0026amp; VSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eVSD closure\u003c/p\u003e\n \u003cp\u003eRV-PA conduit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eMedical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e12\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTOF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eFontan procedure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eMedical\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e13\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eTOF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eFontan procedure\u003c/p\u003e\n \u003cp\u003eRVOT cryoablation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.331723027375201%\" valign=\"top\"\u003e\n \u003cp\u003eNon infected thrombus at ICD wire\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.170692431561998%\" valign=\"top\"\u003e\n \u003cp\u003eThrombus removal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eTypes of Prosthesis infected\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eRight ventricle to pulmonary artery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e4\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eAortic to left ventricle baffle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eProsthetic pulmonary valve\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003eAortic stent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003ePulmonary graft allograft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"50%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026bull;One patient had two prostheses infected, right ventricle to pulmonary artery and aortic to left ventricle baffle\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Prosthetic valve endocarditis, pediatric prosthetic valve infection, congenital heart disease, PET/CT, infective endocarditis","lastPublishedDoi":"10.21203/rs.3.rs-4735687/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4735687/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Pediatric patients with a history of vascular stents or prosthetic valve replacement face an increased risk of infective endocarditis. Echocardiography and cardiac CT can be limited in some cases for diagnosing prosthetic valve endocarditis. PET/CT has shown promise for diagnosis in difficult cases in adults. We reviewed our clinical experience over 13 years and compared surgical findings and clinical outcomes. Utilizing PET/CT as a diagnostic test for prosthetic valve endocarditis in our study resulted in a positive predictive value of 87.5%, a negative predictive value 100% and an accuracy of 92.3%. ","manuscriptTitle":"Utility PET/CT for identifying Prosthetic valve endocarditis in pediatric patients and correlating with outcomes","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-19 15:48:10","doi":"10.21203/rs.3.rs-4735687/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3c32a0ee-a1af-4fba-9ca1-7e3c3a6e85ff","owner":[],"postedDate":"August 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-09-19T15:21:13+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-19 15:48:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4735687","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4735687","identity":"rs-4735687","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}