[99mTc]Tc-HMPAO-WBC SPECT/CT detection and treatment control of infection of the thoracic aortic prosthesis and paraprosthetic area caused by Morganella morganii after frozen elephant trunk surgery

Document Type : Case Report

Authors

1 Nuclear Medicine Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia

2 Сardiac Surgery Department, Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia

Abstract

Vascular grafts and endografts infection (VGEI) are considered rare but the most difficult in cardiovascular surgery. Treatment requires complete replacement of the prosthesis. However, in situations where this is technically impossible, the patient is required to take long-term (sometimes-lifelong) antibiotic therapy. Diagnosis and monitoring of treatment success requires the use of clinical data, imaging techniques, and microbiologic tests. One method for specific imaging of septic inflammation is SPECT/CT with [99mTc]Tc-HMPAO-WBC. According to EANM and ESVS guidelines, [99mTc]Tc-HMPAO-WBC SPECT/CT results definitively confirm or reject the infection. However, the control of treatment efficacy is undiscussed. This report describes a case of severe infection of the prosthesis and paraprosthetic space by Morganella morganii one year after frozen elephant trunk (FET) surgery. We applied a multidisciplinary approach to patient management and monitoring of treatment success in particular using [99mTc]Tc-HMPAO-WBC SPECT/CT.

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Main Subjects


  1. Bashir M, Mohammed I, Al-Tawil M, Jubouri M, Agbobu T, Chen EP. Frozen elephant trunk: the gold standard. Cardiovasc Diagn Ther. 2023 Jun 30;13(3):623-7. 
  2. Bianco V, Kilic A, Gleason TG, Arnaoutakis GJ, Sultan I. Management of thoracic aortic graft infections. J Card Surg. 2018 Oct;33(10):658-65.
  3. Lyons OT, Baguneid M, Barwick TD, Bell RE, Foster N, Homer-Vanniasinkam S, Hopkins S, Hussain A, Katsanos K, Modarai B, Sandoe JA, Thomas S, Price NM. Diagnosis of aortic graft infection: a case definition by the management of aortic graft infection collaboration (MAGIC). Eur J Vasc Endovasc Surg. 2016 Dec;52(6):758-63. 
  4. Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, Esvs Guidelines Committee, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, Document Reviewers, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of vascular graft and endograft infections. Eur J Vasc Endovasc Surg. 2020 Mar;59(3):339-84.
  5. de Vries EF, Roca M, Jamar F, Israel O, Signore A. Guidelines for the labelling of leucocytes with (99m)Tc-HMPAO. Inflammation/infection taskgroup of the European Association of Nuclear Medicine. Eur J Nucl Med Mol Imaging. 2010 Apr;37(4):842-8.
  6. Lauri C, Signore A, Glaudemans AWJM, Treglia G, Gheysens O, Slart RHJA, Iezzi R, Prakken NHJ, Debus ES, Honig S, Lejay A, Chakfé N. Evidence-based guideline of the European Association of Nuclear Medicine (EANM) on imaging infection in vascular grafts. Eur J Nucl Med Mol Imaging. 2022 Aug;49(10):3430-51.
  7. Igrunkova A, Fayzullin A, Serejnikova N, Lipina T, Pekshev A, Vanin A, Zaborova V, Budanova E, Shestakov D, Kastyro I, Shekhter A. Beneficial effects of dinitrosyl iron complexes on wound healing compared to commercial nitric oxide plasma generator. Int J Mol Sci. 2023 Feb 23;24(5):4439.
  8. Phoon PHY, Hwang NC. Deep sternal wound infection: diagnosis, treatment and prevention. J Cardiothorac Vasc Anesth. 2020 Jun;34(6):1602-13.
  9. Inaba Y, Minegishi S, Endo H, Kubota H. Removal of a frozen elephant trunk using a polyvinyl tube. Gen Thorac Cardiovasc Surg. 2022 May;70(5):506-8. 
  10. Laohapensang K, Arworn S, Orrapin S, Reanpang T, Orrapin S. Management of the infected aortic endograft. Semin Vasc Surg. 2017 Jun-Sep;30(2-3):91-4. 
  11. Alsaadi A, Alghamdi AA, Akkielah L, Alanazi M, Alghamdi S, Abanamy H, Aljehani S, Aldibasi OS, Bosaeed M. Epidemiology and clinical characteristics of Morganella morganii infections: a multicenter retrospective study. J Infect Public Health. 2024 Mar;17(3):430-4. 
  12. Zaric RZ, Jankovic S, Zaric M, Milosavljevic M, Stojadinovic M, Pejcic A. Antimicrobial treatment of Morganella morganii invasive infections: Systematic review. Indian J Med Microbiol. 2021 Oct-Dec;39(4):404-12.
  13. Reinders Folmer EI, Von Meijenfeldt GCI, Van der Laan MJ, Glaudemans AWJM, Slart RHJA, Saleem BR, Zeebregts CJ. Diagnostic imaging in vascular graft infection: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2018 Nov;56(5):719-29.
  14. Sollini M, Bartoli F, Boni R, Zanca R, Colli A, Levantino M, Menichetti F, Ferrari M, Berchiolli R, Lazzeri E, Erba PA. Role of multimodal imaging in patients with suspected infections after the bentall procedure. Front Cardiovasc Med. 2021 Dec 1;8:745556. 
  15. Grambow-Velilla J, Mahida B, Benali K, Deconinck L, Chong-Nguyen C, Cimadevilla C, Duval X, Iung B, Rouzet F, Hyafil F. Prognosis and follow-up of patients with prosthetic valve endocarditis treated conservatively in relation to WBC-SPECT imaging. J Nucl Cardiol. 2023 Dec;30(6):2633-43.