Melody® pulmonary valve bacterial endocarditis: Experience in four pediatric patients and a review of the literature. Issue 2 (31st January 2014)

• Record Type: Journal Article
• Authors: Villafañe, Juan; Baker, George Hamilton; Austin, Erle H.; Miller, Stephen; Peng, Lynn; Beekman, Robert
• Is Part Of: Catheterization and cardiovascular interventions. Volume 84:Issue 2(2014:Aug. 01)
• Page Start: 212
• Page End: 218
• Publication Date: 2014-01-31
• Subjects: Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.25375
• Languages: English
• ISSNs: 1522-1946

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ccd25375-sec-0001" sec-type="section"> <title>Objectives</title> <p>The objectives of this manuscript are two‐fold: (a) to describe the clinical characteristics and management of four pediatric patients with bacterial endocarditis (BE) after Melody<sup>®</sup> pulmonary valve implantation (MPVI); and (b) to review the literature regarding Melody<sup>®</sup> pulmonary valve endocarditis.</p> </sec> <sec id="ccd25375-sec-0002" sec-type="section"> <title>Background</title> <p>There are several reports of BE following MPVI. The clinical course, BE management and outcome remain poorly defined.</p> </sec> <sec id="ccd25375-sec-0003" sec-type="section"> <title>Methods</title> <p>This is a multi‐center report of four pediatric patients with repaired tetralogy of Fallot (TOF) and BE after MPVI. Clinical presentation, echocardiogram findings, infecting organism, BE management, and follow‐up assessment are described. We review available literature on Melody<sup>®</sup> pulmonary valve endocarditis and discuss the prognosis and challenges in the management of these patients.</p> </sec> <sec id="ccd25375-sec-0004" sec-type="section"> <title>Results</title> <p>Of our four BE patients, two had documented vegetations and three showed worsening pulmonary stenosis. All patients remain asymptomatic after medical treatment (4) and surgical prosthesis replacement (3) at follow‐up of 17 to 40 months. Analysis of published data shows that over half of patients undergo bioprosthesis explantation and that there is a 13% overall mortality. The most common BE pathogens are the <italic>Staphylococcus</italic> and <italic>Streptococcus</italic> species.</p> </sec> <sec id="ccd25375-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Our case series of four pediatric patients with repaired TOF confirms a risk for BE after MPVI. A high index of suspicion for BE should be observed after MPVI. All patients should be advised to follow lifelong BE prophylaxis after MPVI. In case of BE, surgery should be considered for valve dysfunction or no clinical improvement in spite of medical treatment. © 2014 Wiley Periodicals, Inc.</p> </sec> </abstract>