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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
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Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic

William R Miranda1, Heidi M Connolly2, Crystal R Bonnichsen2

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA miranda.william@mayo.edu.

European Heart Journal. Cardiovascular Imaging
|May 11, 2016
PubMed
Abstract

Insights

Infective endocarditis (IE) of prosthetic pulmonary valves (PPV) or conduits (RVPAC) causes significant complications and often requires surgery. Combined transthoracic and transesophageal echocardiography improve diagnosis.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • Prosthetic pulmonary valve (PPV) and right ventricle to pulmonary artery conduit (RVPAC) infective endocarditis (IE) is a serious complication.
  • Understanding clinical, microbiological, and diagnostic features is crucial for patient management.

Purpose of the Study:

  • To review clinical and microbiological findings of PPV/RVPAC IE in adults.
  • To assess the diagnostic utility of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE).

Main Methods:

  • Retrospective review of 17 adult patients with definite PPV/RVPAC IE (2000-2015).
  • Analysis of clinical presentation, causative organisms, echocardiographic findings (TTE and TEE), and outcomes.
  • Evaluation of diagnostic yield of TTE and TEE, individually and combined.

Main Results:

  • The most common pathogens were Staphylococcus aureus, coagulase-negative staphylococci, and streptococci.
  • 64.5% of patients required PPV/RVPAC replacement surgery; mortality was 17.6%.
  • Combined TTE and TEE diagnosed IE in 88% of cases, while individual TTE (62%) and TEE (57%) had lower yields. Severe obstruction (53%) was more frequent than regurgitation (29%).

Conclusions:

  • PPV/RVPAC IE presents with significant morbidity, mortality, and a high need for surgical intervention.
  • TTE and TEE are valuable complementary diagnostic tools for PPV/RVPAC IE.
  • New-onset PPV/RVPAC obstruction should raise suspicion for IE.
Keywords:
infective endocarditispulmonary valve prosthesisright ventricular to pulmonary artery conduit

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