Pulmonary Valve Endocarditis Research Articles

A Challenging Case of Isolated Pulmonic Valve Endocarditis With Septic Embolic and High-Grade Bacteremia

A Challenging Case of Isolated Pulmonic Valve Endocarditis With Septic Embolic and High-Grade Bacteremia

Isolated pulmonary valve endocarditis in a pediatric patient with down syndrome

BackgroundIsolated pulmonary valve endocarditis (IPE) accounts for less than 2% of all infective endocarditis patients. It is commonly associated with several predisposing factors, including intravenous drug use (IVDU) and congenital heart disease. The most common causative pathogens of IPE are Staphylococcus aureus and Streptococcus viridans. We report a Down’s syndrome patient with IPE and with no standard risk factors caused by the rare pathogen Acinetobacter spp. This led to respiratory failure and systemic infection due to septic pulmonary emboli. Early elective surgery was decided upon as the patient was no longer responding to medical therapy, and his clinical condition was worsening over time.Case presentationA 15-year-old male with Down syndrome and no underlying heart defect presented with a 3-month history of episodic fever, nausea, vomiting, and diarrhea. Transthoracic echocardiography (TTE) revealed large vegetation on the pulmonary valve leaflet, another mobile mass at the pulmonary artery bifurcation, and severe pulmonary regurgitation. Serial blood cultures isolated Acinetobacter spp. Despite initial antibiotic therapy, the patient continued to have sepsis, unresolved vegetations, and developed life-threatening complications and respiratory distress, which convinced us to perform a pulmonary valve replacement surgery with a homograft. After surgery, the patient recovered and was discharged on the ninth postoperative day (POD).ConclusionThis report highlights IPE’s diagnostic and therapeutic challenges, alongside the importance of a comprehensive cardiopulmonary workup in patients with unexplained fever, sepsis, and pulmonary symptoms, even without typical risk factors. Based on the patient’s aggravating condition despite medical treatment, early surgical intervention and pulmonary valve replacement were deemed crucial. However, there still needs to be a definitive guideline on when and how surgery should be performed in patients with complicated IPE, especially in pediatric patients.

Isolated pulmonary valve endocarditis.

Isolated pulmonary valve endocarditis (IPE) is arare form of infectious endocarditis. This article reports the case of a49-year-old patient with IPE who was initially admitted with suspected cholecystitis. After vegetations were detected by transthoracic (TTE) and transesophageal echocardiography (TEE), antibiotic therapy in accordance with the antibiogram was primarily attempted; however, due to persistently elevated infection parameters and structural valve damage apulmonary valve replacement was eventually performed.

Precision Medicine Approach Using Triple Combination Antifungal Therapy for Fusarium Brain Abscesses and Endocarditis in an Adult Burn Patient.

We report a management strategy for disseminated Fusarium solani fungal infection in an adult 35% total body surface area burn patient with brain abscesses and concomitant pulmonic valve endocarditis resulting in the longest survival reported in a burn patient. Early in his hospital course, the patient was diagnosed with a Fusarium burn wound infection with concomitant fungemia and was treated with a prolonged course of intravenous (IV) antifungal monotherapy. Shortly thereafter, he developed focal neurologic deficits and was found to have brain abscesses on MRI. He underwent emergent craniotomy with debridement, and triple antifungal therapy was initiated. Transesophageal echocardiography demonstrated pulmonic valve vegetations, which resolved with triple antifungal therapy. Disseminated Fusarium solani infection is quite rare with mortality approaching 100%. Given the rarity of this disease process, there are no established antifungal treatment guidelines. However, this patient survived for approximately 1 year after diagnosis with treatment including source control via craniotomy and debridement coupled with prolonged courses of combination antifungal therapy (given the near pan-resistance of his fungal infection). Pharmacogenomic testing was utilized to establish the patient's metabolism of voriconazole and dosing adjusted accordingly to improve the efficacy of the combination therapy. To our knowledge, an adult burn patient surviving this length of time after Fusarium brain abscesses with disseminated infection has not been previously described.

Partial heart transplantation for destructive infective endocarditis

Infective endocarditis frequently spreads beyond the valve tissue, especially in the aortic location. Invasive endocarditis may lead to abscess formation or fistula, with substantial tissue loss. Here, the case of a 31-year-old male patient with destructive aortic and pulmonary valve endocarditis and a subaortic mural defect who underwent patch closure of the ventricular septal defect and aortic and pulmonary root replacement and right coronary artery bypass graft is presented. This is an uncommon condition and stress is placed on imaging of the technical aspects of the case.

129 ANCA-associated pauci-immune crescentic necrotizing glomerulonephritis triggered by Bartonella henselae infective pulmonic valve endocarditis confirmed by 18 F-FDG PET/CT scan

129 ANCA-associated pauci-immune crescentic necrotizing glomerulonephritis triggered by Bartonella henselae infective pulmonic valve endocarditis confirmed by 18 F-FDG PET/CT scan

Perforation of the chest wall from bioprosthetic pulmonary valve endocarditis.

Perforation of the chest wall from bioprosthetic pulmonary valve endocarditis.

Severe Pulmonic Valve Endocarditis with Septic Pulmonary Embolism in a Teenager: Case Report

A 14-year-old boy with an uneventful past history suffered from one week of high-grade fever and progressive dyspnea. The patient developed necrotizing pneumonia with massive loculated pleural effusion and septic shock. Echocardiogram revealed a small perimembranous VSD with multiple vegetations at pulmonic valve and both pulmonary arteries. Intravenous antibiotic therapy, mechanical ventilatory support, chest tube placement, and intrapleural fibrinolytic therapy were performed. He was clinically improved after eight weeks of antibiotic therapy. Keywords: Septic pulmonary embolism; Pulmonic valve endocarditis; Infective endocarditis

Bacteria Endocarditis Caused by Mycoplasma hyorhinis in a Juvenile, Immunosuppressed Pig (Sus scrofa domesticus) following Partial Heart Transplantation.

Domestic swine (Sus scrofa domesticus) are important translational models for cardiovascular transplant studies. This can be attributed to the anatomic and physiologic similarities of their cardiovascular system to humans. Transplant studies frequently employ clinically relevant immunosuppression regimens to prevent organ rejection postoperatively. Immunosuppression can lead to opportunistic infection, including presentations that are novel or poorly described in immunocompetent hosts. In this study, we describe the first case of Mycoplasma hyorhinis -induced endocarditis affecting the pulmonary valve in a juvenile, immunosuppressed pig following a partial heart transplantation procedure. Clinical signs of infection began at 15 d postoperation, were consistent with a variety of infectious agents, including Mycoplasma hyorhinis, and included lethargy, respiratory signs, and elevated white blood cell counts. By 28 d post procedure, lameness and soft tissue swelling around the left tarsus developed. Joint fluid obtained by arthrocentesis was PCR positive for Mycoplasma hyorhinis and negative for other tested pathogens. Despite antimicrobial treatment, the transplanted pulmonary valve developed leaflet thickening, stenosis, and insufficiency starting at 30 d after the procedure. At 86 d posttransplantation, the pig reached experimental endpoints and was humanely euthanized for necropsy and histopathology. The pulmonary valve had numerous dark red vegetative expansions of all 3 leaflets. Postmortem testing of a vegetative lesion was positive for Mycoplasma hyorhinis, confirming the etiologic agent responsible for endocarditis. Mycoplasma hyorhinis -induced endocarditis of an orthotopic transplanted pulmonary valve has yet to be described in swine. This case report demonstrates that infections following immunosuppression may present with novel or undercharacterized clinical signs.

Abstract 16833: Native Pulmonary Valve Infective Endocarditis in the Absence of Typical Risk Factors

Introduction: Isolated Pulmonary valve endocarditis (PVE) is a rare subset of right sided endocarditis associated with high mortality. We describe a case of PVE without typical risk factors. Case: A 53-year-old male with a history of controlled type 2 diabetes, coronary artery disease and recent minor trauma to the foot presented with 1 week of intermittent fevers, night sweats, and decreased appetite. Vital signs revealed a temperature of 103°F. Exam was significant for a grade II diastolic murmur best heard on the left sternal border and a healed wound on the left 5th metatarsal. Blood cultures taken grew Methicillin-Resistant Staphylococcus Aureus. A trans-thoracic echocardiogram revealed an echo dense material on the pulmonary valve measuring 1.0 x 0.3 cm. Differential diagnosis included endocarditis, pulmonary fibroelastoma, thrombus, or a cardiac tumor. A trans-esophageal echocardiogram later obtained revealed an echogenic lesion on the pulmonic valve measuring 2.1 x 1.2 cm with severe pulmonic insufficiency. An echodensity adherent to the right ventricular wall was also visualized. Tricuspid valve appeared normal. Due to persistent bacteremia despite appropriate antimicrobial coverage and significant valvular insufficiency, a decision was made to proceed with cardiac surgery. Patient received debridement to both pulmonary valve and right ventricular vegetations and underwent pulmonary valve replacement. Intraoperative pathology was consistent with endocarditis. The nidus for infection was attributed to the patient’s recent traumatic wound. The patient was discharged home with 6 weeks of daptomycin therapy. Conclusion: Right sided endocarditis involving the pulmonic valve is rare but can occur in individuals without an obvious predisposing cardiac structural abnormality. In our case, the patient developed severe valvular insufficiency therefore was successfully treated with surgical intervention and a prolonged course of antibiotics.

Isolated Pulmonary Valve Endocarditis on an Undiagnosed Congenital Heart Disease in a Young Adult: A Rare Clinical Entity

Background: Isolated pulmonary valve endocarditis (PVE) is a rare condition that accounts for 1.5–2% of all reported cases of endocarditis. Herein, we describe a rare case of isolated pulmonary valve endocarditis with a fortuitous discover of a congenital heart disease in a young adult subject. Unlike other cases of right sided endocarditis, we treated our patient both medically and surgically.
 Case Presentation: The patient was diagnosed with an isolated pulmonary valve endocarditis after blood cultures confirming the presence of Abiotrophia defectiva, a germ difficult to cultivate whilst the echocardiographic revealed a vegetation mass measuring 8mm long alongside with the discovery of a severe pulmonary valve stenosis and a large atrial septal defect (ASD) of 39mm wide. Septic pulmonary emboli were the first clinical manifestation in our patient. Both medical and surgical treatment was indicated based on dual antibiotics, removal of the vegetation, valvulotomy and closure of the ASD.
 Conclusion: Both medical and early surgery therapy should be considered in patient with right sided endocarditis associated with congenital heart disease for better clinical outcome.

Pulmonary valve infective endocarditis caused by Mycobacterium abscessus

Infective endocarditis caused by Mycobacterium abscessus is an uncommon event that, when it does occur, usually requires surgical valve replacement. The pulmonary valve is the least common heart valve involved in infective endocarditis. We present a rare case of isolated pulmonary valve endocarditis with Mycobacterium abscessus in a patient with recurrent sternal infections following repeated coronary artery bypass.

Double-Chambered Right Ventricle Presenting in Adulthood With Aortic and Pulmonic Valve Endocarditis

A 55-year-old woman admitted with symptoms of right heart failure received a diagnosis of double-chambered right ventricle and a ventricular septal defect with aortic and pulmonic valve endocarditis. This case highlights the use of multimodality imaging and importance of adult congenital heart disease expertise in the diagnosis and treatment of such patients. (Level of Difficulty: Intermediate.)

Streptococcus oralis pulmonic valve endocarditis: a case report and review of the literature

BackgroundSeveral factors increase the risk of right-sided endocarditis. The tricuspid valve is usually involved in right-sided endocarditis cases. Infective endocarditis of the pulmonic valve is rare, and few cases of pulmonic valve endocarditis were reported previously.Case presentationHere we describe a case of a 81-year-old Middle Eastern male patient, admitted to our hospital three times in a period of 2 months for fever and cough. He had Streptococcus oralis bacteremia with vegetation that was on the pulmonic valve. We diagnosed him with pulmonic valve endocarditis, and he was treated successfully with intravenous antibiotics.ConclusionIt is important to keep high suspicion for isolated pulmonic valve endocarditis in patients with respiratory symptoms. Adequate dental care is important in patients with risk factors for infective endocarditis.

Evaluation of Pulmonary Valve Endocarditis by Electrocardiography-Gated Cardiac Computed Tomography.

Evaluation of Pulmonary Valve Endocarditis by Electrocardiography-Gated Cardiac Computed Tomography.

Septic Cavernous Sinus Thrombosis in a Young Male Presenting With Pneumothorax Secondary to Septic Pulmonary Emboli: A Case Report

Septic pulmonary embolism (SPE) is a rare complication that happens when infected thrombi from the original site of infection break off and travel to the pulmonary blood vessels, causing an infarction or an abscess. Cases were reported on SPE, with tricuspid or pulmonary valve endocarditis being the most common primary site, especially in intravenous drug abusers. There are, however, very few reports of SPE brought on by septic cavernous sinus thrombosis (CST). Here, we describe the case of an 18-year-old male who had a pustule on his left eyelid, after which he developed fever, spontaneous swelling of his left eye, followed by his right eye, along with bilateral proptosis and diplopia, and new-onset dyspnea. Auscultation revealed decreased breath sounds in the left lung fields. Magnetic resonance imaging (MRI) revealed cavernous sinus thrombosis. Blood cultures isolated Staphylococcus aureus species. High-resolution computed tomography (HRCT) revealed a left-sided pneumothorax with minimal pleural effusion and multiple nodules scattered among both lungs, suggesting septic pulmonary emboli. We report this case to convey how a minor lesion, that is, an eyelid pustule (stye), can get complicated and set off a spiral of events that takes an unexpected tangent, challenging physicians and necessitating a rigorous approach.

Isolated native pulmonary valve endocarditis

Isolated native pulmonary valve endocarditis

Atypical Presentation of Infective Endocarditis in a Young Man without Risk Factors: A Case Report

Infective endocarditis is a disease caused by the adherence of infectious agents to the endocardial surface, resulting in inflammation and damage, especially to the heart valves. Endocarditis may be diagnosed in up to 5% of patients with prolonged febrile syndrome. The incidence of endocarditis affecting the right heart chambers ranges from 5% to 10% with predominant involvement of the tricuspid valve. Pulmonary valve involvement is rare and usually associated with immunosuppressive conditions or structurally abnormal hearts. Pulmonary valve endocarditis may present atypically with recurrent respiratory symptoms, so that echocardiography should be considered to assess the presence of right heart lesions, which may be a challenge for suspicion and diagnosis, especially in patients without risk factors. In this study, the authors report a case of isolated infective endocarditis in the pulmonary valve due to Staphylococcus aureus in a young man with recurrent pneumonia episodes and without traditional risk factors. Although technological advances contribute to the diagnosis of complex cases, the clinical approach was the best way to determine the appropriate tests and examinations, and for choosing or developing interventions. Despite the availability of resources and diagnostic tools, many diseases associated with high morbidity and mortality may be misdiagnosed and mistreated, including infective endocarditis. A comprehensive patient assessment is essential for the correct diagnosis, as many signs and symptoms are common to different diseases.

A Case of Isolated Pulmonary Valve Endocarditis: The Importance of Repeat Echography and Microbiology in Diagnosis

A 64-year-old man presented to our centre with a one month history of fatigue, exertional dyspnoea, and worsening lower limb oedema on a background of known HFrEF. Following successful diuresis persistently raised inflammatory markers and intermittent fevers prompted investigation for infective endocarditis (IE). Serial blood cultures grew staphylococcus epidermis which were all, unusually, CO2 dependant and likely from a common source. An initial transthoracic echocardiogram (TTE) showed no evidence of endocarditis and normal Tricuspid (TV) and Pulmonary valves (PV). A subsequent transoesophageal echocardiogram (TOE) showed no significant new valvular abnormality.

Isolated Pulmonary Valve Endocarditis: The use of Homograft when Conservative Strategy is not Possible: A Case Report

Endocarditis isolated from the pulmonary valve is not that common. It has a clinical appearance of right heart endocarditis, with potential pulmonary septic emboli. We report a case of a 14-years-old girl treated for isolated pulmonary valve endocarditis and pulmonary stenosis in which the destruction of the pulmonary valve required the use of a pulmonary homograft for RVOT reconstruction.