Two cases of pulmonary homograft replacement for isolated pulmonary valve endocarditis

Infective Endocarditis during Pregnancy-Keep It Safe and Simple!

The diagnosis of infective endocarditis (IE) during pregnancy is accompanied by a poor prognosis for both mother and fetus in the absence of prompt management by multidisciplinary teams. We searched the electronic databases of PubMed, MEDLINE and EMBASE for clinical studies addressing the management of infective endocarditis during pregnancy, with the aim of realizing a literature review ranging from risk factors to diagnostic investigations to optimal therapeutic management for mother and fetus alike. The presence of previous cardiovascular pathologies such as rheumatic heart disease, congenital heart disease, prosthetic valves, hemodialysis, intravenous catheters or immunosuppression are the main risk factors predisposing patients to IE during pregnancy. The identification of modern risk factors such as intracardiac devices and intravenous drug administration as well as genetic diagnostic methods such as cell-free deoxyribonucleic acid (DNA) next-generation sequencing require that these cases be addressed in multidisciplinary teams. Guiding treatment to eradicate infection and protect the fetus simultaneously creates challenges for cardiologists and gynecologists alike.

Surgical case of isolated pulmonary valve endocarditis in a patient without predisposing factors

We report a case of isolated pulmonary valve endocarditis in a 47-year-old woman without predisposing factors. She had episodes of low-grade fever and non-productive cough and was initially diagnosed with bacterial pneumonia. With antibiotic treatment, her condition improved transiently, but she had repeated respiratory events. Forty days after her first visit, she complained of severe dyspnea. Echocardiography revealed a large vegetation adhering to the pulmonary valve and she was diagnosed with isolated pulmonary valve endocarditis. Surgical treatment was selected because antibiotic treatment was not effective. The main pulmonary artery was transected above the annulus and the infected valve was excised. To avoid contact of the prosthetic valve with the infected pulmonary annulus, a stentless bioprosthesis was interposed between the transected parts of the pulmonary trunk. Two years after the surgery, the patient is stable with no sign of infection.

Fungal native pulmonary valve endocarditis: facing both medical and surgical challenges

Fungal isolated native pulmonary valve endocarditis is extremely uncommon. Data are scarce and report high mortality and recurrence rates. Recommended management combines both medical and surgical approaches. We report herein a rare case of isolated pulmonary valve endocarditis caused by Candida albicans The patient did not display prior heart disease. Medical management was unsuccessful. Pulmonary valve replacement allowed rapid improvement.

Fungal pulmonary valve endocarditis masquerading as a pulmonary embolism

Septic pulmonary emboli (SPE) can be a difficult clinical entity to distinguish from thromboembolic pulmonary embolism (TPE) in a patient with history of IV drug abuse (IVDA). We present a case of a patient who presented with failure to thrive and presumed diagnosis of recurrent PE that ultimately was discovered to have fungal pulmonary valve endocarditis resulting in a right ventricular outflow obstruction. This required replacement of the pulmonary valve and repair of the right ventricular outflow tract. This case highlights difficulty in differentiating pulmonary valve endocarditis with septic emboli from chronic PE in a patient with a complex medical history.

Streptococcus constellatus community acquired pneumonia with subsequent isolated pulmonic valve endocarditis and abscess formation in a structurally normal heart

Pulmonic valve infective endocarditis in isolation is a rare clinical entity. The formation of an abscess in the right ventricular outflow tract as a consequence of vegetations affecting the pulmonic valve in a structurally normal heart is extremely rare and has not been reported. We report a case of isolated pulmonic valve endocarditis complicated by a regional abscess formed within the right ventricular outflow tract caused by Streptococcus Constellatus (S. Constellatus), a member of the Streptococcus Milleri group in a young male whose risk factor was alcohol abuse and he was treated medically, a comprehensive literature review on the subject is also reported. Our case is the first reported in literature with infective endocarditis caused by S. Constellatus affecting the pulmonic valve, and the first with pulmonic valve endocarditis and perivalvular abscess formation in a structurally normal heart.

Surgical valve repair of isolated pulmonary valve endocarditis

Isolated pulmonary valve endocarditis (IPE) is an uncommon clinical entity. We reported 4 cases of IPE without underlying heart diseases that required surgical interventions. Two of the present patients had predisposing factors that included a history of abdominal surgery in Case 1 and intravenous drug abuse in Case 3. All four patients presented with persistent fever together with pulmonary symptoms despite appropriate antibiotic management. Three of the patients underwent elective pulmonary valve repair, but Case 3 underwent an urgent surgical intervention due to uncontrolled septic shock. Pulmonary valve repair was performed using autologous pericardial patch in all 4 patients. All of them had immediate postoperative recovery and satisfactory outcomes in the follow-up.