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Infective Endocarditis Involving the Pulmonary Valve
William R Miranda1, Heidi M Connolly1, Daniel C DeSimone2
1Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
The American Journal of Cardiology
|November 28, 2015
Summary
Pulmonary valve infective endocarditis (PV IE) is rare but serious. This study highlights key clinical features, common pathogens like Enterococcus faecalis, and diagnostic roles of echocardiography in PV IE cases.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Diagnostics
Background:
- Pulmonary valve (PV) infective endocarditis (IE) is an uncommon condition, representing 1.5% to 2% of all IE cases.
- Existing literature on PV IE is sparse, primarily consisting of limited case series and reports.
Purpose of the Study:
- To review the Mayo Clinic's experience with native PV IE.
- To describe the clinical, echocardiographic, and microbiologic characteristics of PV IE patients.
Main Methods:
- Retrospective review of patients diagnosed with native PV IE between 2000 and 2014.
- Inclusion criteria: age ≥18 years with unequivocal echocardiographic evidence of PV involvement.
- Data collected included patient demographics, comorbidities, pathogens, diagnostic imaging, and outcomes.
Main Results:
- Nine patients with PV IE were identified, with 78% having isolated PV IE.
- Common pathogens included Enterococcus faecalis and viridans group streptococci (22% each).
- Transthoracic echocardiogram (TTE) was diagnostic in all cases; transesophageal echocardiogram (TEE) had one false negative.
- 56% of patients underwent PV replacement, with no operative deaths.
Conclusions:
- PV IE, though rare, is associated with significant morbidity.
- Echocardiography (TTE and TEE) plays a crucial role in diagnosis, offering complementary information.
- A high prevalence of immunosuppressive therapy and cardiovascular implantable electronic devices in PV IE patients warrants further investigation.
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