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Iaccarino A, Barbone A, Basciu A, Cuko E, Droandi G, Galbiati D, Romano G, Citterio E, Fumero A, Scarfò I, Manzo R, La Canna G, Torracca L. Surgical Challenges in Infective Endocarditis: State of the Art. J Clin Med 2023; 12:5891. [PMID: 37762834 PMCID: PMC10532218 DOI: 10.3390/jcm12185891] [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: 07/20/2023] [Revised: 08/24/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Infective endocarditis (IE) is still a life-threatening disease with frequent lethal outcomes despite the profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Nowadays, the scenario for IE has changed since rheumatic fever has declined, but on the other hand, multiple aspects, such as elderly populations, cardiovascular device implantation procedures, and better use of multiple imaging modalities and multidisciplinary care, have increased, leading to escalations in diagnosis. Since the ESC and AHA Guidelines have been released, specific aspects of diagnostic and therapeutic management have been clarified to provide better and faster diagnosis and prognosis. Surgical treatment is required in approximately half of patients with IE in order to avoid progressive heart failure, irreversible structural damage in the case of uncontrolled infection, and the prevention of embolism. The timing of surgery has been one of the main aspects discussed, identifying cases in which surgery needs to be performed on an emergency (within 24 h) or urgent (within 7 days) basis, irrespective of the duration of antibiotic treatment, or cases where surgery can be postponed to allow a brief period of antibiotic treatment under careful clinical and echocardiographic observation. Mainly, guidelines put emphasis on the importance of an endocarditis team in the handling of systemic complications and how they affect the timing of surgery and perioperative management. Neurological complications, acute renal failure, splenic or musculoskeletal manifestations, or infections determined by multiresistant microorganisms or fungi can affect long-term prognosis and survival. Not to be outdone, anatomical and surgical factors, such as the presence of native or prosthetic valve endocarditis, a repair strategy when feasible, anatomical extension and disruption in the case of an annular abscess (mitral valve annulus, aortic mitral curtain, aortic root, and annulus), and the choice of prosthesis and conduits, can be equally crucial. It can be hard for surgeons to maneuver between correct pre-operative planning and facing unexpected obstacles during intraoperative management. The aim of this review is to provide an overview and analysis of a broad spectrum of specific surgical scenarios and how their challenging management can be essential to ensure better outcomes and prognoses.
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Affiliation(s)
- Alessandra Iaccarino
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessandro Barbone
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Alessio Basciu
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enea Cuko
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Ginevra Droandi
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Denise Galbiati
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Giorgio Romano
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Enrico Citterio
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Andrea Fumero
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
| | - Iside Scarfò
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Rossella Manzo
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Giovanni La Canna
- Cardiovascular Department, Applied Diagnostic Echocardiography of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (I.S.); (R.M.); (G.L.C.)
| | - Lucia Torracca
- Cardiovascular Department, UO of Cardiac Surgery of IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy; (A.B.); (A.B.); (E.C.); (G.D.); (D.G.); (G.R.); (E.C.); (A.F.); (L.T.)
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Srdanović I, Stefanović M, Miljković T, Bjelić S, Trajković M, Pantić T, Velicki L, Milovančev A. Pulmonary Valve Endocarditis during and beyond Euro ENDO Registry: A Single Center Case Series. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1213. [PMID: 37512025 PMCID: PMC10385559 DOI: 10.3390/medicina59071213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023]
Abstract
Background: Pulmonary valve infective endocarditis (PVIE) is a rare form of infective endocarditis (IE) and is associated with high mortality and severe complications. Guidelines for treatment of this form of IE are scarce and based on general recommendations. We report a case series of PVE. Detailed Case Description: Case 1-A 36-year-old female with congenital pulmonary artery stenosis, dyspnea and leg edema symptoms for 2 months. Blood cultures yielded Staphylococcus spp. and Corynebacterium sp., and echocardiography revealed multiple floating vegetation at the pulmonic valve and surrounding structures. The clinical course was complicated with sepsis and multi-organ failure. Urgent surgery with pulmonary homograft implantation resulted in successful five-year outcome. Case 2-In a 38-year-old male with previous tetralogy of Fallot correction and symptoms of fatigue, fever, myalgia, and photophobia, echocardiography was suggestive of PVIE. The clinical course was complicated with septic shock, multi-organ failure, ischemic stroke with hemorrhagic transformation and death on the 12th day of hospitalization. Case 3-A 41-year-old male without previous medical history was hospitalized due to prolonged fatigue, fever, dyspnea, and leg edema. He was diagnosed with multi-valve infective endocarditis, affecting the aortic, tricuspid, and pulmonary valve. Acute heart failure and hemodynamic instability indicated urgent surgery with aortic valve replacement and reconstruction of the tricuspid and pulmonary valves. At four-year follow up he was doing well. Conclusion: Symptoms in PVIE may be versatile, and diagnosis is often delayed. High level of suspicion, early recognition, and echocardiography are cornerstones in diagnostics. Despite the standpoint that medical therapy is first-line, the role of surgery needs to be advocated in particular cases.
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Affiliation(s)
- Ilija Srdanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Maja Stefanović
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Tatjana Miljković
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Snežana Bjelić
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Miloš Trajković
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Teodora Pantić
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Lazar Velicki
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
| | - Aleksandra Milovančev
- Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia
- Institute of Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia
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Freitas A, Atanásio G, Mascarenhas J. Infective endocarditis of a forgotten valve. ITALIAN JOURNAL OF MEDICINE 2023. [DOI: 10.4081/itjm.2022.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 62-years-old man with interventricular communication was admitted to the hospital with a 6-month history of constitutional symptoms. The patient was feverish and a grade III/VI continuous murmur was noted in all precordium. Patient’s blood analysis showed elevation of inflammatory markers and bacteriaemia caused by Granulicatella adiacens. Transoesophageal echocardiogram diagnosed infective endocarditis of the aortic valve. The patient completed 3 weeks of antibiotic therapy and was submitted to aortic valve replacement and correction of the interventricular communication. Before hospital discharge, routine transthoracic echocardiogram was done and a pulmonary valve vegetation measuring 6x7 mm, not previously described, was noted, as well as de novo severe pulmonary valve insufficiency. The surgical risk was very high in this patient. Antibiotic therapy was extended and the patient was maintained under close follow-up in appointments. The patient remained asymptomatic and clinically stable.
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Mohamed S, Patel AJ, Mazhar K, Osman A, Balacumaraswami L, Ridley P. Native pulmonary valve endocarditis requiring pulmonary valve replacement in adulthood: a case series. J Surg Case Rep 2022; 2022:rjac137. [PMID: 35444791 PMCID: PMC9015772 DOI: 10.1093/jscr/rjac137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Native pulmonary valve endocarditis is a rare phenomenon as native valve endocarditis tends to typically affect the left sided heart valves. However, the right-sided heart valves can be affected in patients with a history of intravenous drug use, whereby the tricuspid valve is most commonly affected. We present two cases who were diagnosed with native pulmonary valve endocarditis in the absence of congenital heart disease. In the first case, the native pulmonary valve endocarditis was probably a derivative of compounding factors of an enlarged underlying pulmonary artery and staphylococcal bacteraemia. In the second case, a common causal organism of native valve endocarditis following dental treatment and the resultant echocardiography findings was of significant interest. In summary, native pulmonary valve endocarditis is relatively rare complication in the adult population, especially in the absence of congenital heart disease.
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Affiliation(s)
- S Mohamed
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - A J Patel
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TT, UK
| | - K Mazhar
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - A Osman
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - L Balacumaraswami
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
| | - P Ridley
- Department of Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke on Trent, UK
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Parato V, Di Geso L, Pelliccioni S, Parato A, Di Eusanio M. Isolated pulmonic valve endocarditis. J Cardiovasc Echogr 2022; 32:119-122. [PMID: 36249431 PMCID: PMC9558633 DOI: 10.4103/jcecho.jcecho_75_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/14/2021] [Accepted: 01/08/2022] [Indexed: 11/04/2022] Open
Abstract
Isolated pulmonic valve infective endocarditis (PV-IE) is a rare form of endocarditis. The authors report a case of giant vegetations detected by transthoracic echocardiography (TTE) on PV in a young patient, 33-year-old, with drug abuse history. The patient underwent surgical intervention by pulmonary valved bioconduit implantation. After operation, a pulmonary embolism episode was treated by a direct oral anticoagulant. The final outcome was favorable. The difficulty in diagnosing PV-IE is due to the inability to properly visualize the PV by echocardiography. In this case, with such large vegetations, TTE allowed a correct diagnosis and an effective surgical planning, confirming its importance as a diagnostic tool.
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Alex J, Patel H, Shah R, Saba S, Zughaib M. Isolated Sub-Pulmonic Valve Endocarditis in a Patient With a History of Konno Procedure and Mechanical Aortic Valve. Cureus 2021; 13:e17594. [PMID: 34646646 PMCID: PMC8483447 DOI: 10.7759/cureus.17594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/19/2022] Open
Abstract
Pulmonic and sub-pulmonic valve endocarditis are rarely encountered in clinical practice. We present the first case of isolated sub-pulmonic endocarditis. A 30-year-old man with a history of mechanical aortic valve presented to the emergency department with multiple complaints including nausea, vomiting, body aches, and fevers. The patient underwent surgical resection for sub-aortic stenosis followed by a modified Konno procedure later in life. A modified basal short-axis view on the trans-thoracic echocardiogram revealed a sub-pulmonic mobile structure highly suggestive of infective endocarditis. Blood cultures grew methicillin-sensitive Staphylococcus aureus within 24 hours. Higher oxygen demand prompted chest imaging, chest CT showed the development of bilateral airspace consolidation, suggestive of pneumonia. After treatment with extended intravenous antibiotics, follow-up echocardiogram four months later showed no identifiable sub-pulmonic vegetation. This case describes a situation where clinicians may suspect infective endocarditis in a typical location such as a mechanical aortic valve. However, in patients who develop pneumonia, infective endocarditis of the right heart should be suspected. The pulmonic valve and sub-pulmonic ridge are often difficult to image given their anatomical location, a modified basal short-axis view on trans-thoracic echocardiogram can better image these structures.
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Affiliation(s)
- Jacob Alex
- Department of Internal Medicine, Ascension Providence Hospital, Southfield, USA
| | - Harshil Patel
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Roshni Shah
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Souheil Saba
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
| | - Marcel Zughaib
- Department of Cardiovascular Medicine, Ascension Providence Hospital, Southfield, USA
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Taskesen T, Gill EA. Pulmonary valve assessment by three-dimensional echocardiography. Echocardiography 2021; 39:1001-1009. [PMID: 33604936 DOI: 10.1111/echo.15001] [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: 01/08/2021] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022] Open
Abstract
The pulmonary valve (PV) has historically been ignored by imaging studies. Disorders of the PV encountered in adult cardiac patients are increasingly encountered due to advanced care of patients with congenital heart disease and associated PV diseases. Despite advances in PV imaging, multiple challenges remain when it comes to obtaining high quality PV images. While 2D TTE is the usual initial imaging tool for PV, excellent views of the PV annulus and its one or two leaflets are obtained in less than half of patients. The 3D echocardiography en face view allows all three leaflets to be evaluated concurrently, as well as assessments of the RV outflow tract and main pulmonary artery, which has improved quantitative assessment of PV diseases. Increasing image quality and experience with live/real time 3D TEE amplifies its utility in accurate evaluation and helps guide and monitor successful percutaneous PV interventions. 2D TTE remains the first line diagnostic tool; however, 3D TTE and 3D TEE provide better image quality which increases diagnostic accuracy and guidance to therapy. In this review article, we stress improvement in 3D echocardiography and its role in diagnostic and therapeutic options for PV diseases.
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Affiliation(s)
- Tuncay Taskesen
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, IA, USA
| | - Edward A Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
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Platz MR, Stöbe S, Baum P, Metze M. Case report: isolated pulmonary valve endocarditis in a 39-year-old patient with intravenous drug abuse. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-6. [PMID: 33442654 PMCID: PMC7793195 DOI: 10.1093/ehjcr/ytaa442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/23/2020] [Accepted: 10/30/2020] [Indexed: 12/05/2022]
Abstract
Background Isolated pulmonary valve endocarditis is a very rare form of right-sided infective endocarditis. Due to the anatomy, in most cases, just the tricuspid valve is involved. Diagnosis can be challenging because of non-specific symptoms (fever, dyspnoea, haemoptysis, and pleuritic chest pain) and difficulty of detection by echocardiography. Risk factors include intravenous drug abuse, congenital heart disorders, alcohol abuse, male sex and central venous catheters, or pacemaker leads. Case summary A 39-year-old homeless male patient, who was a current intravenous drug user, presented with fever, dyspnoea, and haemoptysis. The chest X-ray showed bilateral infiltrates. Empiric antibiotic treatment was initiated. Blood cultures showed the presence of Streptococcus dysgalactiae. Atypical causes of pneumonia were excluded. Systemic embolism was suspected, and a computed tomography scan of brain, thorax, and abdomen was performed. Multiple septic embolic lesions were detected in both lungs. Echocardiography revealed an isolated pulmonary valve endocarditis. Penicillin G and gentamycin were administered intravenously for a duration of 6 and 2 weeks, respectively. The patient was discharged in stable condition but did not return for outpatient clinical appointments. Discussion To detect rare causes of right-sided infective endocarditis, repeated echocardiograms with special focus on the pulmonary valve may be required. Usually, antibiotic treatment alone leads to recovery. In special situations (heart failure, septic shock, or large vegetation size) surgery is required. Due to the high risk of postoperative complications, surgery in intravenous drug users should be avoided if possible.
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Affiliation(s)
- Martin Richard Platz
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Stephan Stöbe
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Paul Baum
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103 Leipzig, Germany
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Hicklin HE, Huang G, Davis KA, Barnes EW, Peacock JE. Pulmonic valve infective endocarditis: transesophageal echocardiography is critical to diagnosis. Infect Dis (Lond) 2020; 52:746-748. [DOI: 10.1080/23744235.2020.1784996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Harry E. Hicklin
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Glen Huang
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Kyle A. Davis
- Department of Pharmacy, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Erin W. Barnes
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
- Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - James E. Peacock
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC, USA
- Section on Infectious Diseases, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment. J Am Heart Assoc 2020; 9:e017293. [PMID: 32700630 PMCID: PMC7792231 DOI: 10.1161/jaha.120.017293] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Compared with the extensive data on left-sided infective endocarditis (IE), there is much less published information on the features and management of right-sided IE. Right-sided IE accounts for 5% to 10% of all IE cases, and compared with left-sided IE, it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right-sided IE we provide an up-to-date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.
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Affiliation(s)
- Hezzy Shmueli
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Felix Thomas
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | - Nir Flint
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA.,Department of Cardiology Tel Aviv Sourasky Medical Center Affiliated to the Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Gayatri Setia
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
| | | | - Robert J Siegel
- Smidt Heart Institute Cedars-Sinai Medical Center Los Angeles CA
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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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Jhaveri S, Saarel EV, Stewart RD, Tan C, Komarlu R. Isolated Endocarditis of Native Pulmonary Valve in a Pediatric Patient: The Unusual within the Unusual. ACTA ACUST UNITED AC 2019; 4:69-73. [PMID: 32337393 PMCID: PMC7175791 DOI: 10.1016/j.case.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Native PV IE is extremely rare. Recurrent septic emboli from PV IE may masquerade as severe pneumonia. Failure of medical management may require surgical removal of the focus of infection. TEE is used as an adjunct to TTE to better delineate PV endocarditis.
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Affiliation(s)
- Simone Jhaveri
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Elizabeth V Saarel
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
| | - Robert D Stewart
- Pediatric and Congenital Heart Surgery, Cleveland Clinic Children's, Cleveland, Ohio
| | - Carmela Tan
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Rukmini Komarlu
- Department of Pediatric Cardiology, Cleveland Clinic Children's, Cleveland, Ohio
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Taskesen T, Prabhu SJ, Steinberg ZL, Oxorn D, Gill EA. Feasibility of pulmonary valve imaging using transesophageal echocardiography upper esophageal view. Echocardiography 2019; 36:930-937. [PMID: 31002189 DOI: 10.1111/echo.14332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The present study designed to evaluate feasibility of transesophageal echocardiographic (TEE) imaging of the pulmonary valve (PV) at the transaortic upper esophageal (TAUE) window. We hypothesized that patients with larger aorta would be more likely to have visualization of the PV from this TAUE window. METHODS 2D TEE images of the PV were prospectively acquired by one operator at the TAUE window looking through the aortic arch. Patients were divided into four groups based on image quality of PV (group 1, not visualized; group 2, barely visualized; group 3, sufficient visualization; group 4, excellent visualization). Clinical, echocardiographic, and radiologic parameters were collected. RESULTS A total of 212 consecutive patients (54 ± 14 years, 63.7% male) were enrolled. Group distribution was as follows: group 1, n = 60 (28.3%); group 2 n = 39 (18.4%); group 3, n = 27 (12.7%); group 4, n = 86 (40.6%). There were no differences between groups' baseline clinical characteristics. There was a weak although statistically negative correlation between PV image quality and aortic arch dimension (r = -0.17 P = 0.01). There was a stronger positive correlation between PV thickness (r = 0.38 P < 0.001) and PV image quality. Retrospective subgroup analysis of 76 patients with recent chest CT showed similar, but not significant trends as by TEE. CONCLUSION The use of 2D TEE TAUE results in diagnostic image quality of the PV in the majority of patients and outstanding image quality in a subset of patients. PV image quality is negatively affected by increasing aorta diameter and positively affected by PV thickness.
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Affiliation(s)
- Tuncay Taskesen
- Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Somnath J Prabhu
- Division of Radiology, University of Washington, Seattle, Washington
| | | | - Donald Oxorn
- Division of Cardio-Thoracic Anesthesia, University of Washington, Seattle, Washington
| | - Edward A Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado
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Samaroo-Campbell J, Hashmi A, Thawani R, Moskovits M, Zadushlivy D, Kamholz SL. Isolated Pulmonic Valve Endocarditis. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:151-153. [PMID: 30713335 PMCID: PMC6369649 DOI: 10.12659/ajcr.913041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided endocarditis is in itself rare, with some studies reporting an incidence of 5-10%. The majority of these cases involve the tricuspid valve, and isolated pulmonary valve endocarditis (PVE) is an extremely rare entity affecting less than 2% of patients with infective endocarditis. Identification and early management are crucial to prevent long-term complications and reduce mortality. CASE REPORT We present a patient with a history of essential hypertension and no underlying valvular disease, who underwent dental cleaning and subsequently developed low-grade fever, myalgia, and malaise. This occurred during the flu season, and was initially diagnosed and treated as flu, without any improvement. The patient was later found to be bacteremic with S. mitis, with no identifiable source, and a normal transthoracic echocardiogram (TTE). He was later hospitalized, had a transesophageal echocardiogram, and was found to have a large pulmonic valve vegetation. CONCLUSIONS This case presents an interesting and rare finding of endocarditis, isolated to the pulmonic valve, in an otherwise healthy individual with no predisposing risk factors. The lack of peripheral stigmata, as well as an unremarkable initial outpatient TTE, made the diagnosis more difficult. It should also be noted that current guidelines do not specifically address right-sided endocarditis, and do not specify the role of surgical intervention.
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Affiliation(s)
| | - Arsalan Hashmi
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Rajat Thawani
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | - Manfred Moskovits
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
| | | | - Stephan L Kamholz
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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Vrettos A, Mota P, Nash J, Thorp I, Baghai M, Marzetti A. Pneumococcal pulmonary valve endocarditis. Echo Res Pract 2017; 4:ERP-17-0026. [PMID: 28634177 PMCID: PMC5516544 DOI: 10.1530/erp-17-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 06/20/2017] [Indexed: 12/03/2022] Open
Abstract
Pulmonary valve endocarditis is an rare type of infective endocarditis (IE). Streptococcus pneumoniae is a pathogen that is uncommonly associated with IE. A 50 year-old man was referred to us to an incidental echocardiographic finding of a pulmonary valve vegetation. He had a recent admission for drainage of a scrotal abscess from which streptococcus pneumoniae was isolated, complicated by hospital acquired pneumonia and pulmonary embolism. Analysis using Polymerase Chain Reaction of the surgically resected mass revealed signs of 16S rDNA consistent with Streptococcus pneumoniae infection. This is the first confirmed case of pneumococcal pulmonary valve IE presenting entirely asymptomatically in the absence of any known risk factors.
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Affiliation(s)
- Apostolos Vrettos
- Cardiology, East Kent Hospitals University NHS Foundation TrustWilliam Harvey Hospital, Ashford, UK
| | - Paula Mota
- Cardiology, East Kent Hospitals University NHS Foundation TrustWilliam Harvey Hospital, Ashford, UK
| | - James Nash
- Microbiology, East Kent Hospitals University NHS Foundation TrustWilliam Harvey Hospital, Ashford, UK
| | - Iain Thorp
- Echocardiography, East Kent Hospitals University NHS Foundation TrustWilliam Harvey Hospital, Ashford, UK
| | - Max Baghai
- Cardiothoracic Surgery, King’s College London School of Medical Education, London, UK
| | - Adam Marzetti
- Echocardiography, East Kent Hospitals University NHS Foundation TrustWilliam Harvey Hospital, Ashford, UK
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