Pulmonary valve infective endocarditis in an adult patient with severe congenital pulmonary stenosis and ostium secundum atrial septal defect

Pulmonary valve infective endocarditis in an adult patient with atrial septal defect presenting with multiple pulmonary emboli - A case report

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.

Native pulmonary valve endocarditis requiring pulmonary valve replacement in adulthood: a case series

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.

The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020

Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.

Pulmonary endarteritis and endocarditis complicated with septic embolism: a case report and review of the literature

Background

Pulmonary endarteritis is a rare clinical phenomenon with congenital heart that can potentially lead to major complications.

Case presentation

We report a 47-year-old man with pulmonary endarteritis. This patient presented with hypertension, chest pain and a previous history of pulmonary valve disease during childhood. Also, eight-months prior, he was hospitalized with dyspnea (Functional Class III), cough, phlegm, and night sweats without fever. Echocardiographic diagnosis in the first transtransthoracic echocardiography (TTE) was intense pulmonary valve stenosis (PVS) an, thus, the pulmonary valve vegetation and PVS, established by transesophageal echocardiography (TEE). He was referred for surgery after 1 weeks of intravenous antibiotic therapy for removal of the vegetation.

Conclusions

Finally he was asymptomatic at 3-months of follow-up and was clinically in good condition. Therefore, the detection of infective endocarditis of the lung valve must not lengthy be prolonged.

Right-sided infective endocarditis: recent epidemiologic changes

BACKGROUND

Infective endocarditis (IE) has been increasingly reported, however, little is available regarding recent development of right-sided IE.

METHODS

Right-sided IE was comprehensively analyzed based on recent 5⅓-year literature.

RESULTS

Portal of entry, implanted foreign material, and repaired congenital heart defects were the main predisposing risk factors. Vegetation size on the right-sided valves was much smaller than those beyond the valves. Multiple logistic regression analysis revealed that predisposing risk factors, and vegetation size and locations were independent predictive risks of patients' survival.

CONCLUSIONS

Changes of right-sided IE in the past 5⅓ years included younger patient age, and increased vegetation size, but still prominent Staphylococcus aureus infections. Complication spectrum has changed into more valve insufficiency, more embolic events, reduced abscess formation, and considerably decreased valve perforations. With effective antibiotic regimens, prognoses of the patients seemed to be better than before.