Patients who have undergone cardiac surgery using prosthetic devices have an increased risk of developing prosthetic device-related infection and mediastinitis. However, accurate diagnosis of prosthetic device-related infection can be difficult to evaluate and treat with antibiotic therapy alone. In recent years, 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET-CT) has made promising contributions to detect infective endocarditis, pacemaker infections, or other inflammations. Nevertheless, 18F-FDG PET-CT for congenital heart disease (CHD) with device infection has been sparsely reported. We present an infantile girl diagnosed with pulmonary atresia with a ventricular septal defect who underwent replacement of the right ventricle-to-pulmonary artery (RV-PA) conduit for improvement cyanosis. She developed high fever and was diagnosed with mediastinitis and bacteremia by Pseudomonas aeruginosa (P. aeruginosa) on postoperative day 4. Mediastinal drainage and 6 weeks of antibiotic therapy improved her condition, but bacteremia flared up on postoperative day 56. Despite a long course of antibiotic therapy, she had two more recurrences of bacteremia with the detection of P. aeruginosa. Echocardiography and chest contrast CT showed no evidence of vegetation and mediastinitis. On postoperative day 115, 18F-FDG PET-CT revealed an accumulation on the RV-PA conduit (SUV max 3.4). Finally, she developed an infectious ventricular pseudo-aneurysm on postoperative day 129 and underwent aneurysm removal and RV-PA conduit replacement on postoperative day 136. Our case showed the importance of 18F-FDG PET-CT for diagnosing specific localization of prosthetic device-related infection which is hard to detect using other imaging techniques. It can be a useful diagnostic tool for infantile patients with CHD with cardiac prosthetic devices and improve subsequent clinical treatments.
A male neonate born at 33 weeks of gestation was orally administered caffeine from the 2nd to the 13th days of life for the management of apnoea of prematurity with several episodes of bradycardia. Paroxysmal bradycardia recurred at 23 days of age, indicating that the treatment was ineffective. A physical examination at 31 days of age revealed no hypothermia or other abnormalities. Laboratory findings at 35 days of age showed no abnormalities in the serum electrolyte, thyroid hormone, creatinine kinase, or troponin-I levels. The serum samples were also negative for Anti-SS-A and anti-SS-B antibodies. Other serum findings were as follows: epinephrine, 17 pg/mL (normal < 100 pg/mL); norepinephrine, 1205 pg/mL (normal < 450 pg/mL); and dopamine, 38 pg/mL (normal < 20 pg/mL). The urinary metanephrine-to-creatinine ratio was 2.06 (normal < 0.5). The chest radiography, echocardiography, brain magnetic resonance imaging and video electroencephalography findings were normal. His resting heart rate was 150-170 beats/
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