Other com- plications include HF (20% 50%), paravalvular cardiac abscesses (30% 40%), neurological manifestations (30%), and systemic emboliza- 11. When compared with native valve endocarditis, prosthetic valve endocarditis is characterized by a lower incidence of vegetations (especially in mechanical prostheses) and a higher incidence of annular abscess and other paravalvular complica- tions. Because cardiac auscultation may also be less revealing in prosthetic valve endocarditis and because ordinarily less virulent organisms may cause more anatomic destruction before culture or serological detection, early use of TEE in these high-risk patients is important. The sensitivity of TEE for detecting IE is lower with prosthetic valves than with native valves, so the importance of comparing serial echocardiographic studies is paramount to making the diagnosis.59,60 12. Electrocardiographic-synchronized, multidetector- row CT is emerging as an important tool for non- invasive cardiac assessment and may be helpful in evaluating complications of IE. CT may also be indicated in right-sided IE to demonstrate the pres- ence of septic pulmonary infarcts and abscesses. Although CT is less accurate than TTE and TEE for identifying valvular vegetation and valvular perfo- rations, CT is useful for evaluating patients with equivocal findings on TEE and for evaluating com- plications in patients with suspected paravalvular infection. CT imaging is particularly useful in pre- operative evaluation of patients with aortic valve IE to evaluate coronary artery and aortic involve- ment. In suspected prosthetic valve endocarditis, cardiac CT is less affected by the shadowing of mechanical valves or bioprosthetic valve sew- ing rings than is ultrasonography. CT also allows evaluation of the motion of mechanical valve occluders and provides visualization of throm- bus or infective material limiting valve occluder motion. 