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Ignatius R, Stephen T, Varun C. Pulmonary valve infective endocarditis in an adult patient with atrial septal defect presenting with multiple pulmonary emboli - A case report. J Cardiol Cases 2023; 28:109-112. [PMID: 37671258 PMCID: PMC10477041 DOI: 10.1016/j.jccase.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 09/07/2023] Open
Abstract
Isolated pulmonary valve (PV) infective endocarditis (IE) is a rare entity accounting for <2 % of all cases of IE. Risk of PV IE in patients with atrial septal defect (ASD) is considered negligible and there have only been a few cases reported to date. We describe a case of a 51-year-old woman with an ostium secundum ASD with associated PV endocarditis, who presented with multiple pulmonary septic emboli. Initially we tried antibiotic therapy and later she underwent successful surgery with ASD closure, vegetectomy, and PV repair. We want to draw attention to the possibility of IE of PV in a patient with ASD and report successful management with surgery and good recovery following treatment. Learning objective In this study, we highlight the importance of keeping a strong clinical suspicion of infective endocarditis (IE) in patients presenting with fever and a pulmonary focus, especially in the setting of congenital heart disease (including even atrial septal defect). We also discuss the possible indications for surgical management in patients with pulmonary valve IE.
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Affiliation(s)
- Remil Ignatius
- Department of Cardiac Surgery, Medical Trust Hospital, Ernakulam, Kerala, India
| | - Thomas Stephen
- Department of Cardiac Surgery, Medical Trust Hospital, Ernakulam, Kerala, India
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Lim WJ, Kaisbain N, Kim HS. Septic pulmonary emboli in pulmonary valve endocarditis with concurrent ventricular septal defect and coronary artery disease: a case report. Eur Heart J Case Rep 2022; 6:ytac162. [PMID: 35481258 PMCID: PMC9036074 DOI: 10.1093/ehjcr/ytac162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/14/2021] [Accepted: 04/08/2022] [Indexed: 12/04/2022]
Abstract
Background Infective endocarditis (IE) is one of the common causes of life-threatening infections. Compared to left-sided endocarditis, right-sided infective endocarditis is rarer, with pulmonary valve endocarditis much rarer than the tricuspid valve. Its diagnosis poses a challenge, owing to its rarity, low index of clinical suspicion, and lack of availability of appropriate diagnostic measures. Risk factors include indwelling central venous catheter, sepsis, intravenous drug use, pacemaker with lead infection, or ventricular septal defect (VSD). Case summary We describe a case of pulmonary valve endocarditis that led to septic pulmonary emboli in a patient scheduled for elective bypass surgery for triple vessel disease. There was an incidental finding of VSD on echocardiography, which is also a risk factor for pulmonary valve endocarditis owing to the jet of VSD to the pulmonary valve. The patient was given 4 weeks of antibiotics and subsequently underwent coronary artery bypass graft, pulmonary valve replacement, and VSD closure. Discussion Our case demonstrated the importance of high clinical suspicion and vigilance of diagnosing pulmonary valve endocarditis when dealing with pyrexia of unknown origin in a patient with a congenital VSD as VSD-associated pulmonary valve endocarditis remained a rare disease. Besides, an active search for clinical and radiological signs of pulmonary embolization is necessary in patients with right-sided endocarditis especially those with large and mobile vegetation. A conservative approach or valve repair is recommended for most patients with right sided IE affecting the tricuspid or pulmonary valve.
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Affiliation(s)
- Wei Juan Lim
- Department of Cardiology, Institute Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Neerusha Kaisbain
- Department of Medicine, Hospital Sultanah Aminah Johor Bahru, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia
| | - Heng Shee Kim
- Department of Medicine, Hospital Sultanah Aminah Johor Bahru, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor, Malaysia
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Malavia G, Sharma S. Pulmonary valve infective endocarditis: A case series. Ann Pediatr Cardiol 2021; 14:496-500. [PMID: 35527748 PMCID: PMC9075556 DOI: 10.4103/apc.apc_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 11/04/2022] Open
Abstract
Background and Objectives: Methods: Results: Conclusions:
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Isaza N, Shrestha NK, Gordon S, Pettersson GB, Unai S, Vega Brizneda M, Witten JC, Griffin BP, Xu B. Contemporary Outcomes of Pulmonary Valve Endocarditis: A 16-Year Single Centre Experience. Heart Lung Circ 2020; 29:1799-1807. [PMID: 32616369 DOI: 10.1016/j.hlc.2020.04.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 10/11/2019] [Accepted: 04/28/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Limited data exist regarding the clinical characteristics and contemporary outcomes of patients with pulmonary valve (PoV) infective endocarditis (IE). METHODS This is a retrospective cohort study of patients with a confirmed diagnosis of IE affecting the PoV at our centre between January 2002 and October 2018. Electronic medical records were reviewed to gather the clinical and echocardiographic variables. The population was subdivided according to risk factor profiles: group 1: miscellaneous risk factors; group 2: patients with congenital heart disease (CHD); and group 3: patients who inject drugs (PWID). The primary outcome was all-cause mortality. RESULTS Out of 2,124 cases of IE during the study period, 24 (1.1%) patients had PoV IE. The majority of cases of PoV IE occurred in patients with prosthetic valves (54.2%). Coagulase-negative Staphylococci species were the most common micro-organisms. Seventy-five per cent (75%) of the patients required surgical management. The median follow-up was 2.8 years (interquartile range: 0.2-5.3 years). Patients with miscellaneous risk factors were older (p<0.01), and had higher rates of hypertension (p=0.01) and hyperlipidaemia (p=0.04). There was a statistically significant difference in survival between the groups (p=0.03), mainly driven by better outcomes of patients with CHD, compared to those with miscellaneous risk factors. CONCLUSIONS In a contemporary 16-year series, a high proportion of patients with PoV IE required surgical management. Patients with PoV IE and CHD had better survival, compared to patients with miscellaneous risk factors at a median follow-up of 2.8 years.
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Affiliation(s)
- Nicolas Isaza
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nabin K Shrestha
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Steven Gordon
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Gosta B Pettersson
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Maria Vega Brizneda
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - James C Witten
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
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Corey KM, Campbell MJ, Hill KD, Hornik CP, Krasuski R, Barker PC, Jaquiss RDB, Li JS. Pulmonary Valve Endocarditis: The Potential Utility of Multimodal Imaging Prior to Surgery. World J Pediatr Congenit Heart Surg 2020; 11:192-197. [PMID: 32093564 DOI: 10.1177/2150135119896287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The presence of echocardiographic (echo) evidence is a major criterion for the diagnosis of infective endocarditis (IE) by modified Duke criteria. Pulmonary valve (PV) IE, however, can be challenging to identify by echo. We sought to evaluate the added utility of multimodal imaging in PV IE. METHODS This is a single-center case series. We retrospectively analyzed demographic, laboratory, imaging, clinical, and surgical data from patients diagnosed with PV IE from 2008 to 2018. RESULTS A total of 23 patients were identified with definite PV IE by Duke criteria (83% male and ages 2 months to 70 years). Twenty-two patients had congenital heart disease, with 21 involving the right ventricular outflow tract (including three with transcatheter PV implant). Overall, 20 (87%) of 23 had positive blood cultures. A total of 17 (74%) of 23 patients demonstrated echo evidence of PV IE. In three cases, echo was negative (did not show vegetations) but showed new PV obstruction. In four cases with negative transthoracic echocardiogram and transesophageal echocardiogram, evidence of PV IE was subsequently seen by positron emission tomography/computed tomography (n = 2) or cardiac magnetic resonance imaging (n = 2). Pulmonary valve IE was confirmed at surgery by evaluation of pathologic samples in 20 cases. CONCLUSIONS Multimodal imaging improves the ability to preoperatively identify endocardial involvement in PV IE in cases where echo is negative. Consideration should be given to revise Duke criteria to include new obstruction and endocardial involvement by multimodal imaging for PV IE.
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Affiliation(s)
| | | | - Kevin D Hill
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Richard Krasuski
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Piers C Barker
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Robert D B Jaquiss
- Department of Surgery, University of Texas Southwestern, Dallas, TX, USA
| | - Jennifer S Li
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
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Poon WB, Lian WB. Recurrent Group B Streptococcal Septicemia in a Very Low Birth Weight Infant with Infective Endocarditis and Submandibular Cellulitis. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n12p936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Darwazah AK, Hawari MH, Qaqa Z, Abu Sham'a RAH, Sharabati B. Visceral leishmaniasis complicated by fungal pulmonary valve endocarditis. J Infect 2006; 53:e185-9. [PMID: 16473409 DOI: 10.1016/j.jinf.2005.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 11/20/2005] [Accepted: 12/09/2005] [Indexed: 10/25/2022]
Abstract
We present a rare neglected case of fungal pulmonary valve endocarditis which presented with typical extra cardiac manifestations after repeated injections for treatment of visceral leishmaniasis. Surgical intervention to replace the pulmonary valve was the only option to manage the patient in spite of extensive medical treatment.
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Affiliation(s)
- Ahmad K Darwazah
- Department of Cardiac Surgery, Makassed Hospital, Mount of Olives, PO Box 19482, Jerusalem, Israel.
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