Diagnostic Cardiac Catheterization Research Articles

Metformin Continuation Versus Holding Pre and Post Coronary Angiography with Normal Renal Function: A Systematic Review and Meta-Analysis

Background It is common practice to withhold metformin prior to cardiac catheterization due to fear of developing lactic acidosis in the setting of contrast-associated acute kidney injury (AKI). The evidence behind this recommendation is currently weak. Methods We collected 851 articles from PubMed and Embase, of which 3 met our inclusion criteria. Inclusion criteria were age > 18 years, baseline use of long-term metformin with continued or interrupted metformin use in patients during diagnostic or interventional cardiac catheterization. The outcomes studied were differences between post-catheterization and pre-catheterization serum creatinine (SCr) and glomerular filtration rate (GFR). We excluded studies dealing with patients not on long-standing metformin and those in which contrast exposure was through contrast enhanced computerized tomography. We used Hedges’s g with inverse variance method to pool standard mean difference with a random effects model using meta-cont module in CRAN-R software with 95% confidence interval (CI) for statistical significance. Higgins I-squared (I²) statistic was used to evaluate heterogeneity. Results . Post-catheterization serum creatinine (Hedges’s g = -0.12 mg/dL; CI = -0.83 to +0.6, p = 0.75, I2 = 95%), post-catheterization GFR (Hedges’s g = +0.18 mL/min; CI = -0.76 to +1.11, p = 0.71, I2 = 97%) and post-catheterization lactate levels (Hedges’s g = +0.03 mg/dL; CI = -0.66 to +0.72, p = 0.75, I2 = 95%) failed to reach statistical significance. Conclusions There is no statistically significant difference in SCr or GFR between patients who held metformin prior to cardiac catheterization and those who continued taking the medication.

Clinical Outcomes and Satisfaction Level among Patients Undergoing Diagnostic Cardiac Catheterization

Clinical Outcomes and Satisfaction Level among Patients Undergoing Diagnostic Cardiac Catheterization

Combination of high-flow nasal oxygen and ketamine/dexmedetomidine sedation for diagnostic catheterization in a child with pulmonary arterial hypertension: a case report

Pulmonary hypertension is associated with significant risk of perioperative life-threatening events. We present a case of a 12-year-old child with severe pulmonary arterial hypertension who successfully underwent diagnostic cardiac catheterization under ketamine and dexmedetomidine sedation with the support of high-flow nasal oxygen. Ketamine and dexmedetomidine are reported to have minimal effect on pulmonary vasculature in children with pulmonary hypertension and can be safely used in this population along with its lack of respiratory depression. Positive pressure generated by high-flow nasal oxygen improves upper airway patency, prevents micro-atelectasis, and is shown to improve the effectiveness of ventilation and oxygenation in patients under sedation breathing spontaneously. The presented strategy may contribute to enhancing the safety and effectiveness of procedural sedation for children with life-threatening pulmonary hypertension.

Cardiac Catheterization in Port Harcourt: Initial Two Years’ Experience

Introduction: Cardiac catheterization for diagnostic and therapeutic purposes is now routinely done at the Save a Life Port Harcourt, since last two years. Also included are cardiac devices which include pacemakers, Implantable Cardiac Defibrillators and Cardiac Resynchronization Therapy. In this retrospective study, we review our initial two years’ experience of Cardiac Catheterization at the Save a Life Mission Hospital, Port Harcourt. Methods: This is a retrospective study over a period of two years, form 1st February, 2021 to 31st March, 2023. A total of 216 consecutive diagnostic and therapeutic cardiac catheterization including cardiac devices performed in Save a life Mission Hospital between 1st February 2021 to 31st March 2023 were evaluated. Among them 88; (40.7%) were coronary angiogram, 41 (18.98%) percutaneous transluminal coronary angioplasty (PTCA) and stenting, 59(27.3%) permanent pacemaker insertion, 29 (13.4%) Implantable cardioverter defibrillators, 14 (6.5%) cardiac resynchronization therapy and 26 (12.1%) with peripheral angiography. Six patients were referred for coronary artery bypass surgery. Vascular complications [groin hematoma] occurred in two patients (0.9%). Conclusion: Both diagnostic and therapeutic cardiac catheterization procedures are safe with very low risk of complications even in its initial experience. The optimate goal of these procedures is to ensure the safety of the patients.

Variations of the Femoral Artery Position in Relation to Femoral Vein and Mid-inguinal Point: A Cadaveric Study

Introduction: Femoral artery is one of the major arteries in human body. It is more preference for catheterization in some medical procedures. This study was designed to identify anatomical variations of the femoral artery position, in relation to femoral vein and mid-inguinal point of human cadavers. Methods: Dissection was performed on 22 cadavers. The associations were analyzed using Fisher’s Exact test and correlation test. Results: There was superolateral positioning detected. Distal traversing was only observed on the left thigh. Bivariate analysis showed that there was a significant association of distance from anterior superior iliac spine (ASIS) to femoral artery between the right and left thigh. However, there was no significant association of distance from mid-inguinal point (MIP) to femoral artery between the right and left thigh, position of femoral artery to MIP between the right and left thigh and distance of traversing point between the right and left thigh. Conclusion: This study showed that distance from ASIS to mid-point of femoral artery was significantly associated with the left-right sided of cadavers, while distance from MIP to femoral artery, position of femoral artery to MIP and distance of traversing point were not significantly associated with the left-right sided of cadavers. These informations may help in diagnostic cardiac catheterization procedures and coronary interventions.

Computed Tomographic Evaluation of Congenital Left Ventricular Outflow Obstruction.

Congenital left ventricular outflow obstruction represents a multilevel obstruction with several morphological forms. It can involve the subvalvular, valvar, or supravalvular portion of the aortic valve complex, and may coexist. Computed tomography (CT) plays an important supplementary role in the evaluation of patients with congenital LVOT obstruction. Unlike transthoracic echocardiography and cardiovascular magnetic resonance (CMR) imaging, it is not bounded by a small acoustic window, needs for anaesthesia or sedation, and metallic devices. Current generations of CT scanners with excellent spatial and temporal resolution, high pitch scanning, wide detector system, dose reduction algorithms, and advanced 3-dimensional postprocessing techniques provide a high-quality alternative to CMR or diagnostic cardiac catheterization. Radiologists performing CT in young children should be familiar with the advantages and disadvantages of CT and with the typical morphological imaging features of congenital left ventricular outflow obstruction.

Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices

Background Bed rest duration following deployment of a vascular closure device after transfemoral left-sided cardiac catheterization is not standardized. Despite research supporting reduced bed rest, many hospitals require prolonged bed rest. Delayed ambulation is associated with back pain, urine retention, difficulty eating, and longer stay. Objective To study length of stay, safety, and opportunity cost savings of reduced bed rest at a large urban hospital. Methods A single-site 12-week study of 1-hour bed rest after transfemoral cardiac catheterizations using vascular closure devices. Results were compared with historical controls treated similarly. Results The standard bed rest group included 295 patients (207 male, 88 female; mean [SD] age, 64.4 [8.6] years). The early ambulation group included 260 patients (188 male, 72 female; mean [SD] age, 64 [9.3] years). The groups had no significant difference in age (t634 = 1.18, P = .21) or sex (χ12=0.2, P = .64). Three patients in the standard bed rest group and 1 in the early ambulation group had hematomas (P = .36). The stay for diagnostic cardiac catheterizations was longer in the standard bed rest group (mean [SD], 220.7 [55.2] minutes) than in the early ambulation group (mean [SD], 182.1 [78.5] minutes; t196 = 4.06; P < .001). Stay for percutaneous coronary interventions was longer in the standard bed rest group (mean [SD], 400.2 [50.8] minutes) than in the early ambulation group (mean [SD], 381.6 [54.7] minutes; t262 = 2.86; P = .005). Conclusion Reduced bed rest was safe, shortened stays, and improved efficiency by creating opportunity cost savings.

THU306 Association Of Prediabetes With Cardiovascular Outcomes Among Veterans With Obesity

Abstract Disclosure: J. Pendse: None. J. Mathew: None. S. Maidman: None. K. Mangalick: None. A. Ramachandran: None. E. Siddiqui: None. J.O. Aleman Diaz: None. Introduction: Prediabetes occurs frequently in obesity and is independently associated with increased atherosclerosis in nondiabetic patients. We sought to compare the effects of prediabetes on cardiovascular interventions along the glycemic control spectrum in obesity within the Veterans Health Administration (VHA), the largest US healthcare system. Methods: We conducted a systematic, retrospective review using the VHA Corporate Data Warehouse through the Veterans Administration Informatics and Computing Infrastructure database. We compared patients with obesity and prediabetes (preDM) to patients with obesity and normoglycemia (NG). Inclusion criteria included a body mass index (BMI) ≥ 30 kg/m2, Hemoglobin A1C (HbA1c) < 6.5% between 2000 and 2016. The intervention group included patients with preDM, defined by HbA1c between 5.7% to less than 6.5%, and the control group included patients with NG, defined as HbA1c< 5.7%. The primary endpoint was incidence of coronary revascularization, defined as a composite of percutaneous cardiac intervention (PCI) or coronary artery bypass graft (CABG). Secondary outcomes included PCI, CABG, diagnostic cardiac catheterizations, and mortality. Groups were compared using Pearson’s Chi-squared test or student t-tests when appropriate with alpha set to 0.05, and were assumed to have normal distribution. Results: A total of 137,487 subjects were included in the study, with 91,611 subjects with preDM and 45,876 subjects with NG. The average BMI among the preDM group was 33.8 kg/m2 ± 3.6 and the average BMI among the NG group was 33.4 kg/m2 ± 3.3 (p<0.001). Obesity/preDM subjects had a higher rate of coronary revascularization (6.3%, n=5,749) compared to obesity/NG subjects (3.1%, n=1,408) (p<0.001). From a total of 7,157 revascularized veterans, all-cause mortality rate was increased in preDM subjects (6.6%, n=851) compared to NG subjects (5.8%, n=221) (p<0.001). Obesity/preDM subjects had a higher rate of all-cause mortality (3.9%, n=3607) compared to obesity/NG subjects (2.8%, n= 1273). Also of note, obesity/preDM subjects had higher rates of diagnostic catheterization (11.9%, n=10,858), PCI (5.4%, n=4,913), stent (0.57%, n=528), CABG (1.2%, n=1087) compared with rates in obesity/NG subjects with diagnostic catheterization (7.1%, n=3272), PCI (2.6%, n=1183), stent (0.30%, n=138), and CABG (0.56%, n=258). Evaluating composite cardiovascular outcomes including PCI, stent, and CABG, obesity/preDM subjects had higher rates (6.3%, n=5749) compared with obesity/NG subjects (3.1%, n=1408). Conclusion: In this retrospective study, we have concluded that veterans diagnosed with obesity/preDM had higher rates of composite cardiovascular outcomes, including significantly higher rates of coronary revascularization procedures, overall mortality, and mortality following revascularization compared to veterans with obesity/NG. Presentation: Thursday, June 15, 2023

Changes in the Cath Lab in the Treatment of Adult Patients with Congenital Heart Disease: A 12-Year Experience in a Single Referral Center with the Establishment of a Dedicated Working Group.

Adults with congenital heart disease (ACHD) are a growing population needing ongoing care. The aim of this study was to investigate if a dedicated ACHD team impacted the timing and indication of invasive cardiology procedures in these patients at our hospital. Our retrospective single-center study enrolled adult patients with moderate or complex congenital heart disease and with at least one cardiac catheterization between January 2010 and December 2021. According to the period, procedures were labeled as group A (2010 to 2015) or group B (2016 to 2021) and further divided into diagnostic (DCC) and interventional cardiac catheterizations (ICC). 594 patients were eligible for the study. Both DCC (p < 0.05) and ICC increased between groups A and B (p < 0.05). In group B: Fontan patients accounted for the majority of DCC (p < 0.001), while DCC decreased in arterial switch repair (p < 0.001). In Fontan patients, conduit stenting was prevalent (p < 0.001), while fenestration closures dropped (p < 0.01). In patients with tetralogy of Fallot and native outflow tract, percutaneous pulmonary valve implantations (PPVI) increased, with a concurrent reduction in pulmonary valve replacements (p < 0.001 vs. surgical series). In right ventricular conduits, ICC increased (p < 0.01), mainly due to PPVI. Among Mustard/Senning patients, baffle stenting increased from Group A to Group B (p < 0.001). In patients with pulmonary atresia and biventricular repair, ICC often increased for pulmonary artery stenting. A dedicated working group could improve ACHD patients' indications for interventional procedures, leading to tailored treatment, better risk stratification and optimizing time until heart transplantation.

Transcatheter Management of Pulmonary Sequestrations in Children-A Single-Center Experience.

A pulmonary sequestration (PS) is an area of bronchopulmonary tissue with aberrant arterial supply. Transcatheter occlusion of PSs is an appealing treatment option, but data on outcomes remain scarce. We aim to describe our experience with transcatheter management of PS in infants and children. Retrospective review of clinical data of all patients with suspected PS sent for diagnostic and/or interventional cardiac catheterization at our institution between January 1999 and May 2021. Procedural considerations, techniques, standard safety, and outcomes were assessed. We identified 71 patients (52.1% males), with median age and weight of 4.9 months (IQR, 2.1-26.6) and 4.2 kg (IQR, 3.9-12.1), respectively. Sixty-one (86%) patients had associated congenital heart defects (CHDs). Forty-two (59%) patients had pulmonary arterial hypertension (PAH) at the time of diagnosis. Fifty-three (74.7%) patients underwent embolization of the PS feeding vessel using microcoils and/or vascular plugs, and eight (15.1%) of these were neonates who presented with severe PAH and cardiac failure. Two patients had large feeding vessels and were treated surgically. Sixteen (22.5%) patients with small feeding vessels received conservative management. At median follow-up of 36.4 months (IQR, 2.1-89.9), seven patients had died, 24 patients had CHD corrective surgeries, 26 patients had redo catheterizations, and five patients had persistent PAH. No PS surgical resection was needed, and no infection of the remaining lung tissue occurred. Transcatheter assessment and treatment of PSs is a safe and effective procedure. Neonates with large PSs are severely symptomatic and improve remarkably after PS closure. PS embolization and surgical repair of associated CHDs generally leads to the normalization of pulmonary pressures.

Late surgical ventricular septal defect closure in a low middle-income country setting: a case series

BackgroundVentricular septal defect (VSD) is the commonest type of congenital heart lesion accounting for up to 40% of congenital heart defects. Well timed VSD closures are reported to yield excellent long-term outcomes. Late surgical VSD closures, particularly from the developing countries, are infrequently reported.Case presentationWe report three cases of African children aged between 13 and 14 years who had late VSD presentations. They reported complaints of growth failure and recurrent respiratory infections since early infancy which necessitated frequent visits to primary health care facilities. They were found to have large ventricular septal defects by thoracic echocardiography. Diagnostic cardiac catheterization was done to all three patients to rule out irreversible pulmonary hypertension. After promising cardiac catheterization findings, they all underwent successful surgical VSD repair with good early outcomes.ConclusionVSD surgical closure is ideal in children below 2 years, however, it can be done in children who present at advanced age despite being considered high risk patients. All three of our patients who presented late had successful surgical VSD repairs with promising immediate outcome. The role of genetics in the protection against developing irreversible pulmonary vascular disease in these patients is a possible area for future studies.

Diagnostic cardiac catheterization in a modified cardiac catheterization laboratory: The LASUTH experience

Cardiac catheterization is useful in the diagnosis and treatment of congenital and acquired cardiac diseases. However, it is rarely done in Nigeria because of the limited cardiac catheterization laboratories in the country. Transforming the existing operating theaters to modified catheterization laboratories may bridge the gap of limited cardiac catheterization. This study reviewed the procedures, outcomes, and challenges of a modified catheterization laboratory in Nigeria. A retrospective review of all diagnostic cardiac catheterizations at the modified catheterization laboratory of Lagos State University Teaching Hospital (LASUTH) between January and May 2022 was performed. A total of 8 adult and 4 pediatric patients had cardiac catheterization, and the mean age was 23.7 ± 16.9 (range: 2 – 52) years. The most common lesion was the ventricular septal defect. Complex congenital heart disease was seen in 16% of subjects, whereas pulmonary hypertension was found in 83% (10). The most common complication was transient bradycardia. Good surgical outcome was recorded in the patients who subsequently had corrective surgeries. A modified catheterization laboratory may be a suitable alternative to the standard catheterization laboratory in low-resourced countries.

B-8 | A Comparison of Continued vs Interrupted Use of Metformin in Patients Undergoing Diagnostic or Interventional Cardiac Catheterization: A Systematic Review and Meta-Analysis

B-8 | A Comparison of Continued vs Interrupted Use of Metformin in Patients Undergoing Diagnostic or Interventional Cardiac Catheterization: A Systematic Review and Meta-Analysis

PATIENT DOSIMETRY SURVEY OF PEDIATRIC DIAGNOSTIC AND THERAPEUTIC CARDIAC CATHETERISATION IN JAPAN.

To propose reference values for air-kerma at the reference point (Ka,r), air-kerma area product (PKA), fluoroscopy time (FT) and number of cine images (CI) for four age groups in Japan, a nationwide questionnaire was posted to 132 pediatric catheterisation of certified facility in Japan, using the conventional post system, to which 43 facilities responded. For diagnostic cardiac angiography, reference values were as follows: Ka,r: 86, 102, 165 and 264mGy; PKA: 9.3, 9.5, 16 and 34Gy.cm2; FT: 33, 29, 26 and 30min and CI: 1904, 1966, 2405 and 1871 images. For therapeutic cardiac angiography, reference values were as follows: Ka,r: 107, 163, 103 and 202mGy; PKA: 7.5, 18, 7 and 24Gy.cm2; FT: 56, 52, 42 and 30min and CI: 3886, 3232, 2212 and 4316 images for less than 1, 1-5, 6-10 and 11-15y, respectively. To optimal patient exposure from diagnostic and therapeutic cardiac catheterisation, it is therefore necessary to establish reference values for pediatric cardiac catheterisation examinations for four age groups.

Exploring procedure duration and risk for serious adverse events during congenital cardiac catheterization

ObjectivesWhile procedure length is considered an important metric for cardiothoracic surgical procedures, the relationship between procedure length and adverse events (AEs) in congenital cardiac catheterizations has little published data available....

Gender-based time discrepancy in diagnosis of coronary artery disease based on data analytics of electronic medical records.

Women continue to have worse Coronary Artery Disease (CAD) outcomes than men. The causes of this discrepancy have yet to be fully elucidated. The main objective of this study is to detect gender discrepancies in the diagnosis and treatment of CAD. We used data analytics to risk stratify ~32,000 patients with CAD of the total 960,129 patients treated at the UCSF Medical Center over an 8 year period. We implemented a multidimensional data analytics framework to trace patients from admission through treatment to create a path of events. Events are any medications or noninvasive and invasive procedures. The time between events for a similar set of paths was calculated. Then, the average waiting time for each step of the treatment was calculated. Finally, we applied statistical analysis to determine differences in time between diagnosis and treatment steps for men and women. There is a significant time difference from the first time of admission to diagnostic Cardiac Catheterization between genders (p-value = 0.000119), while the time difference from diagnostic Cardiac Catheterization to CABG is not statistically significant. Women had a significantly longer interval between their first physician encounter indicative of CAD and their first diagnostic cardiac catheterization compared to men. Avoiding this delay in diagnosis may provide more timely treatment and a better outcome for patients at risk. Finally, we conclude by discussing the impact of the study on improving patient care with early detection and managing individual patients at risk of rapid progression of CAD.

Pediatric cardiac services in Sudan: Achievements, challenges, and future perspectives (2004-2021).

Pediatric cardiology (PC) is a rapidly advancing specialty addressing a large population of children as well as adults with congenital heart disease. It requires huge technical and financial resources; therefore, establishing, maintaining, and developing such services in limited resource settings are challenging. A PC program that includes clinical aspects, echocardiography, diagnostic and interventional cardiac catheterization and cardiac surgery, and rheumatic heart disease control was established in Sudan in 2004. There are currently three public centers with facilities to evaluate and treat children with heart disease: two in Khartoum and one in Wad Medani. Major obstacles include the shortage of trained personnel and operation rooms, the deficiency of intensive care facilities, and the financial burden of interventional procedures. This paper details the establishment and progress of the program, its challenges, potential solutions, and future perspectives for PC programs in Sudan and African countries.

Abstract 14155: Concomitant Use of Creatine Kinase MB and High-Sensitivity Troponin: What is the Cost?

Introduction: AHA/ACC guidelines recommend the use of serial high sensitivity troponin (hs-Tn) assays to assess for cardiac injury 1 and addition of CK-MB adds no benefit. However, in the clinical setting, CK-MB assays continues to be ordered concomitantly with hs-Tn in evaluation of suspected myocardial injury/infarction. We performed this study to determine whether the addition of CK-MB to hs-Tn alters diagnostic or therapeutic decisions and to determine its effect on patient outcomes. The financial aspects of this practice were also analyzed Methods: We performed a retrospective review of patients in the Geisinger Health care system from 2018 through 2021. Those having both a CK-MB and a hs-Tn drawn within 24 hours were included. Test results were categorized as concordant or discordant. Patient demographics, clinical profiles, medications and rates of diagnostic cardiac catheterization and subsequent PCI and primary admission and discharge diagnosis were collected from the EMR and analyzed. We used Medicare reimbursement data for estimates of financial impact. Results: A total of 18,727 unique patients had a CK-MB and hs-Tn performed within a 24-hour window. Of these, 49.1% (9,149) had concordant values and 50.9% (9,533) had discordant values. Of those with discordant results, 8,801 (92.3%) patients had abnormal hs-Tn result but normal CK-MB. Abnormal CK-MB with a normal hs-Tn was resulted in 840 patients (8.8%). There was a total of 42,276 CK-MB determinations during our study timeframe which averages out to 2.3 CK-MB/patient. Medicare reimbursement for CKMB is $11.55. Conclusions: This 3-year study demonstrates clinicians still frequently ordered CKMB in patients with concomitant hs-Tn determinations and 49.1%% results are concordant with hs-Tn results yielding no additional clinical information versus use of hs-Tn alone. The cost of this practice is estimated at $239,749.31 for the study period. Data on patients with discordant results and impact on decision process and cost is under analysis and will be available for presentation.

Abstract 13804: Effect of Cardiac Catheterization Timing on In-Hospital Outcomes for Patients Presenting With Non ST Elevation Myocardial Infarction on the Weekend

Introduction: Patients admitted to hospital for non-ST elevation myocardial infarction (NSTEMI) on a weekend have higher rates of mortality. Delayed catheterization and revascularization have been hypothesized as a potential etiology. Few studies have evaluated the timing of catheterization and outcomes for NSTEMIs occurring on the weekend. Hypothesis: Delayed catheterization in patients with NSTEMI on a weekend is associated with higher mortality. Methods: The National Inpatient Sample Database was queried from 2016-2019. Baseline characteristics and in-hospital outcomes of NSTEMI were compared in patients who presented on the weekend based on timing of diagnostic cardiac catheterization. Multivariate logistic-regression was performed for the effect of cardiac catheterization timing on mortality. A p-value was considered significant when &lt;0.001. Results: We found a total of 275,545 hospital admissions occurring on the weekend for patients with a primary diagnosis of NSTEMI. Patients were classified in 3 categories. Early catheterization 98,005 (36%) defined as catheterization on or before hospital day 1, delayed catheterization 102,850 (37%) defined as catheterization on or after hospital day 2, and patients that were not catheterized 74,690 (27%). Among patients who received catheterization, mortality was significantly higher in patients who received delayed catheterization 2.9% vs 1.3%, p&lt;0.001. Patients who underwent delayed catheterization had higher odds of mortality compared to early catheterization (adjOR 1.83 95% CI [1.69-1.98]). Highest mortality presented in patients who did not receive catheterization 10.4%, p&lt;0.001 (adjOR 3.39 [3.23-3.56]). Among patients who died without receiving catheterization (n=7,770), 51.6% died within 2 days of hospitalization. Conclusion: For patients presenting with a NSTEMI on the weekend, delayed catheterization is associated with higher mortality.

Infekcyjne zapalenie wsierdzia u chłopca z zespołem Downa po operacji kardiochirurgicznej w okresie niemowlęcym i usunięciu 13 zębów w piątym roku życia

A 14-year-old boy with Down’s syndrome and an atrioventricular septum defect underwent cardiosurgical treatment at 3 months of age. The postoperative course included pericardiocentesis due to fluid accumulation, anemia, lack of body weight increase, and kidney failure. In the years that followed, the boy’s condition was stable, although he often suffered from infections. The reconstructed mitral valve showed good function, the leaflets were not thickened. At 5 years of age, the patient underwent extraction of 13 teeth consecutively, due to extensive inflammatory changes, without antibiotic cover. The child’s health deteriorated after the procedure. Inflammation indicators were positive and symptoms of sepsis appeared. Physical examination revealed splenomegaly, and Streptococcus mitis and Staphylococcus hominis bacteria were cultured in the blood culture. Transthoracic echocardiography and transesophageal echocardiography showed a hyperechogenic structure of 10 × 4 mm on the mitral valve, causing a narrowing of the inflow to the left ventricle and an exacerbation of grade I to III valve regurgitation as well as features of pulmonary hypertension. Vegetation in the course of infectious endocarditis was suspected and intensive antibiotic therapy was initiated in accordance with the antibiogram. After obtaining sterile cultures, the boy underwent diagnostic cardiac catheterization, which showed postcapillary type reversible pulmonary hypertension. The child was qualified for cardiac surgery during which the vegetation was removed and the Medtronic Hancock 23 mm biological valve was implanted in the mitral field. The boy’s condition has systematically improved and he is currently under outpatient control. After several years of follow-up, the mitral valve shows slight regurgitation. Also, a mild obstruction of the left ventricle outflow tract is observed, not requiring any intervention at the moment.