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Infective endocarditis following percutaneous pulmonary valve replacement: diagnostic challenges and application of
Gary Cheung1, Niels Vejlstrup, Nikolaj Ihlemann
1Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
Background:
Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.
Method And Result:
This study is a retrospective review of all patients with Melody valve implantation in a tertiary centre. Between November 2006 and November 2012, 43 procedures were performed in 42 patients (mean age 25 years, 6-67 years). At a median follow-up of 27 months (2-66 months), six patients were suspected for IE. However, repeated transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed no evidence of IE and the patients were diagnosed as possible cases according to the modified Duke's criteria. Two patients did not respond to antibiotic treatment and underwent intra-cardiac echocardiography (ICE), which clearly demonstrated vegetations. These two cases required surgical explantation, while the other four patients were treated medically without complications.
Conclusion:
IE after Melody valve implantation is uncommon, but difficult to verify since TTE and TEE often cannot demonstrate vegetations inside the stent. ICE should be considered in suspected cases of IE following PPVR with negative TTE and TEE examinations in order to early tailor the best treatment for the individual patient suspected for IE.
Insights
Infective endocarditis after Melody valve replacement is rare but challenging to diagnose. Intra-cardiac echocardiography is crucial for detecting vegetations when other methods fail.
Area of Science:
- Cardiology
- Medical Devices
- Infectious Diseases
Background:
- Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is a rare complication.
- Diagnosing IE in this context presents challenges, particularly in visualizing vegetations via standard echocardiography.
Observation:
- A retrospective review of 43 Melody valve implantations (2006-2012) identified six patients with suspected IE.
- Transthoracic (TTE) and transesophageal echocardiography (TEE) were inconclusive in diagnosing IE for these patients.
- Intra-cardiac echocardiography (ICE) successfully identified vegetations in two patients who did not respond to antibiotics.
Findings:
- IE after Melody valve implantation is uncommon.
- Standard echocardiographic methods (TTE, TEE) often fail to detect vegetations within the Melody valve prosthesis.
- ICE proved effective in diagnosing IE when TTE and TEE were negative.
Implications:
- Consider intra-cardiac echocardiography (ICE) for suspected IE cases post-PPVR with negative TTE/TEE.
- Early and accurate diagnosis facilitates timely and appropriate treatment for patients with suspected IE.
- This approach can help tailor the best treatment strategy for individual patients.
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