A 73-year old man presented with a posterolateral ST-elevated myocardial infarction 9 months after biological aortic valve replacement for aortic valve stenosis. Invasive coronary angiography showed a filling defect across the left main coronary artery bifurcation extending into the left anterior descending artery and the ramus circumflex. Transthoracic echocardiography revealed a thickened prosthesis leaflet with signs of slight stenosis. Cardiac computed tomography angiography showed a mass on the left coronary cusp of the valve prosthesis, suggestive for vegetation or thrombus. The scan also revealed central luminal filling defects, indicative for thrombus or septic emboli. Blood cultures proved positive for Propionibacterium acnes, therefore the patient was treated for prosthetic valve endocarditis. Computed tomography angiography offers high diagnostic accuracy for detecting infective endocarditis and renders complementary information about valvular anatomy, coronary artery disease and the extension of infections.
Keywords: Computed tomography; computed tomography coronary angiography; coronary embolization; invasive coronary angiography; prosthetic heart valve; prosthetic heart valve endocarditis; prosthetic valve thrombosis; transesophageal echocardiography.
Copyright Journal of Radiology Case Reports.