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Isolated pulmonary valve endocarditis in a pediatric patient with down syndrome

Mehrdad Salehi1, Morteza Foroumandi2, Sahand Siami3

  • 1Department of Cardiothoracic Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, End of Keshavarz Boulevard, Tehran, 1419733141, Iran.

Journal of Cardiothoracic Surgery
|August 27, 2024
PubMed

Insights

Isolated pulmonary valve endocarditis (IPE) in a Down syndrome patient was caused by rare Acinetobacter spp. Early pulmonary valve replacement surgery was crucial for recovery when medical therapy failed.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pediatrics

Background:

  • Isolated pulmonary valve endocarditis (IPE) is rare, <2% of infective endocarditis cases.
  • Commonly linked to IV drug use and congenital heart disease.
  • Staphylococcus aureus and Streptococcus viridans are typical pathogens.

Observation:

  • A 15-year-old male with Down syndrome presented with a 3-month history of fever, nausea, vomiting, and diarrhea.
  • Transthoracic echocardiography showed large pulmonary valve vegetation and severe pulmonary regurgitation.
  • Blood cultures identified Acinetobacter spp. as the causative agent.

Findings:

  • Despite antibiotic treatment, the patient experienced persistent sepsis and respiratory distress.
  • Pulmonary valve replacement surgery with a homograft was performed due to deteriorating condition.
  • The patient recovered and was discharged on postoperative day 9.

Implications:

  • Highlights diagnostic and therapeutic challenges of IPE, especially with rare pathogens.
  • Emphasizes comprehensive cardiopulmonary workup for unexplained sepsis and pulmonary symptoms.
  • Suggests early surgical intervention is critical in severe, medically refractory IPE cases, particularly in pediatric patients.
Abstract

Keywords:
Acinetobacter spp.Down syndromeEarly surgeryHomograftIsolated pulmonary valve endocarditisPulmonary valve replacementRight-sided infective endocarditisSeptic pulmonary embolism

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