Infective endocarditis following percutaneous pulmonary valve replacement: Diagnostic challenges and application of intra-cardiac echocardiography

2013 ◽  
Vol 169 (6) ◽  
pp. 425-429 ◽  
Author(s):  
Gary Cheung ◽  
Niels Vejlstrup ◽  
Nikolaj Ihlemann ◽  
Samer Arnous ◽  
Olaf Franzen ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Percutaneous Pulmonary Valve

Usefulness of intracardiac echocardiography for the diagnosis of infective endocarditis following percutaneous pulmonary valve replacement

2017 ◽  
Vol 27 (7) ◽  
pp. 1406-1409 ◽  
Author(s):  
Sara Bouajila ◽  
Aurélie Chalard ◽  
Claire Dauphin
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Transoesophageal Echocardiography ◽  
Intracardiac Echocardiography ◽  
Pulmonary Valve Replacement ◽  
Melody Valve ◽  
Percutaneous Pulmonary Valve

AbstractInfective endocarditis is a serious complication occurring after percutaneous pulmonary valve replacement with a Melody valve; it is of uncertain incidence, and presents a challenging diagnosis. Vegetations may be difficult to visualise with transthoracic and transoesophageal echocardiography. We report the role of intracardiac echocardiography in this condition by confirming the prosthesis involvement.

scholarly journals Risk of infective endocarditis among patients with tetralogy of fallot

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Havers-Borgersen ◽  
J.H Butt ◽  
M Groening ◽  
M Smerup ◽  
G.H Gislason ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Cox Regression ◽  
Pulmonary Valve Replacement ◽  
Varying Coefficients ◽  
Background Population ◽  
Increased Risk

Abstract Introduction Patients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple surgical and interventional procedures including pulmonary valve replacement (PVR). The overall survival of patients with ToF has increased in recent years. However, data on the risk of adverse outcomes including IE are sparse. Purpose To investigate the risk of IE in patients with ToF compared with controls from the background population. Methods In this nationwide observational cohort study, all patients with ToF born in 1977–2017 were identified using Danish nationwide registries and followed from date of birth until occurrence of an outcome of interest (i.e. first-time IE), death, or end of study (July 31, 2017). The comparative risk of IE among ToF patients versus age- and sex-matched controls from the background population was assessed. Results A total of 1,156 patients with ToF were identified and matched with 4,624 controls from the background population. Among patients with ToF, 266 (23.0%) underwent PVR during follow-up. During a median follow-up time of 20.4 years, 38 (3.3%) patients and 1 (0.03%) control were admitted with IE. The median time from date of birth to IE was 10.8 years (25th-75th percentile 2.8–20.9 years). The incidence rates of IE per 1,000 person-years were 2.2 (95% confidence interval (CI) 1.6–3.0) and 0.01 (95% CI 0.0001–0.1) among patients and controls, respectively. In multivariable Cox regression models, in which age, sex, pulmonary valve replacement, and relevant comorbidities (i.e. chronic renal failure, diabetes mellitus, presence of cardiac implantable electronic devices, other valve surgeries), were included as time-varying coefficients, the risk of IE was significantly higher among patients compared with controls (HR 171.5, 95% CI 23.2–1266.7). Moreover, PVR was associated with an increased risk of IE (HR 3.4, 95% CI 1.4–8.2). Conclusions Patients with ToF have a substantial risk of IE and the risk is significantly higher compared with the background population. In particular, PVR was associated with an increased risk of IE. With an increasing life-expectancy of these patients, intensified awareness, preventive measures, and surveillance of this patient group are advisable. Figure 1. Cumulative incidence of IE Funding Acknowledgement Type of funding source: None

The Use of Intracardiac Echocardiography During Percutaneous Pulmonary Valve Replacement

2014 ◽  
Vol 36 (1) ◽  
pp. 76-83 ◽  
Author(s):  
Sawsan M. Awad ◽  
Syed Asif Masood ◽  
Ismael Gonzalez ◽  
Qi-Ling Cao ◽  
Ra-id Abdulla ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Intracardiac Echocardiography ◽  
Pulmonary Valve Replacement ◽  
Percutaneous Pulmonary Valve

scholarly journals Infective Endocarditis After Transcatheter Pulmonary Valve Replacement Using the Melody Valve

2013 ◽  
Vol 6 (3) ◽  
pp. 292-300 ◽  
Author(s):  
Doff B. McElhinney ◽  
Lee N. Benson ◽  
Andreas Eicken ◽  
Jacqueline Kreutzer ◽  
Robert F. Padera ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Melody Valve ◽  
Transcatheter Pulmonary Valve Replacement

Percutaneous pulmonary valve replacement using completely tissue-engineered off-the-shelf heart valves: six-month in vivo functionality and matrix remodelling in sheep

2016 ◽  
Vol 12 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Boris Schmitt ◽  
Hendrik Spriestersbach ◽  
Darach O h-Icí ◽  
Torben Radtke ◽  
Marco Bartosch ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Heart Valves ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Percutaneous Pulmonary Valve

Abstract 2347: Pulmonary Regurgitation: The Impact on Right Ventricle and the Effect of Percutaneous Pulmonary Valve Replacement

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Lars Søndergaard ◽  
Niels G Vejlstrup ◽  
Simone Theilade ◽  
Jens C Nilsson ◽  
Younes Boudjemline ◽  
...  
Keyword(s):  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Volume Overload ◽  
Pulmonary Valve Replacement ◽  
Group A ◽  
The Impact ◽  
Group D ◽  
Percutaneous Pulmonary Valve ◽  
Rv Function

Background Despite successful repair of tetralogy of Fallot (TOF), the life expectancy for these patients remains lower than in the general population. This is mainly due to free pulmonary regurgitation (PR). The importance of maintaining a competent valve has been emphasized, but the optimal timing for intervention remains to be established. The purposes of this study were in a pig model to investigate the consequences of the duration of free PR on RV, and the reversibility of these changes after percutaneous pulmonary valve replacement. Methods Thirtysix farm pigs were divided into four groups (A, B, C and D) of nine pigs. At baseline group A, B and C had a percutaneous stent inserted into the pulmonary annulus to create free PR. After 4, 8 and 12 weeks, respectively, group A, B and C underwent percutaneous valve replacement. In order to allow remodelling of RV, the pigs were observed for four weeks after valve insertion before euthanasia. To examine RV function, MRI was performed before stent insertion, before valve replacement, and before euthanasia. Group D served as controls and underwent five MRI examinations: at baseline as well as after four, eight, twelve and sixteen weeks. Results When comparing the group D with group A, B & C, RVEDV and RVESV were found to gradually increase over time. Furthermore, these volumes normalised after valve replacement in group A and B, but remains increased in the group C. Similar, RVEF was normal after valve replacement in group A and B, but impaired in the group the long-term free PR compared to the controls. Conclusion Better timing of valve replacement in patients with free PR after TOF repair is of outermost clinical relevance. This study examined the impact of free PR on RV in a pig model. Despite the relative short duration of the volume overload, the RV underwent irreversible changes. This may be explained by the fact that, in contrast to TOF, the RV is not hypertrophic. The study showed that RV tolerates volume overload from free PR for a certain time, but too late intervention will cause irreversible deterioration of the ventricular function. Thus, the model may serve to identify predictors, e.g. tissue-Doppler measurements or natriuretic peptides, for RV function after valve replacement and thereby optimise timing of intervention.

Impact of a structured patient education programme on early diagnosis of prosthetic pulmonary valve endocarditis

2021 ◽  
pp. 1-6
Author(s):  
Daniela Babic ◽  
Ramona Hämmerli ◽  
Bruno Santos Lopes ◽  
Christine Attenhofer Jost ◽  
Daniel Tobler ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Patient Education ◽  
Early Diagnosis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Education Programme ◽  
Pulmonary Valve Replacement ◽  
High Dose ◽  
Valve Function ◽  
Patient Education Programme

Abstract Background: Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes. Methods: A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme. Results: Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset of symptoms and diagnosis of infective endocarditis was 6 days (range: 0–133 days) with a significantly longer delay among patients in cohort 1, compared to cohort 2 (25 days, range: 5–133 days versus 3 days, range: 0–13 days, p < 0.0001). A delay of >7 days was documented in 11/13 patients (85%) in cohort 1 as compared to 1/13 (8%) in cohort 2 (p < 0.001). Need for urgent valve replacement or permanent deterioration of prosthetic valve function was higher in cohort 1, compared to cohort 2 (11/13, 85% versus 5/13, 39%; p = 0.041). Conclusions: Prosthetic pulmonary valve endocarditis is increasingly recognised. A structured patient education programme may improve early diagnosis and clinical outcomes.

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