A Case of Fatal Septic Pulmonary Embolus Arising from an Infected Sano Conduit

Abstract

A 5-month-old boy who had previously undergone a modified Norwood procedure for hypoplastic left heart syndrome presented for elective cardiac catheterization before undergoing the next stage of repair. The catheterization demonstrated mild stenosis of the right ventricle-to-pulmonary artery Sano conduit. The patient became hypoxic and febrile at the end of the procedure and died in the intensive care unit the next day. Postmortem examination demonstrated a vegetation containing Gram-positive cocci in the conduit and a right upper lobe lung abscess also containing Gram-positive cocci. The authors report the first case of Sano shunt endocarditis further complicated by septic pulmonary embolus and review similar infections in this population. Shunt infection may be an underrecognized cause of interstage mortality among patients undergoing a modified Norwood procedure.

Infective Endocarditis in Childhood: 2015 Update

“…12 Endocarditis may manifest as a late complication, with presentation years after congenital heart surgical repair, and may be associated with a fulminant course or antibiotic failure. 14,15 The incidence of IE in the first postoperative month is low for most defects and increases with time after surgery. An exception to this trend is that when prosthetic valves or conduits are used in surgical repairs and hemodynamic problems persist, the risk of IE is high even in the immediate postoperative period (first 2 weeks after surgery).…”

“…Septic vegetations at these sites may lead to dehiscence, obstruction, or distal emboli. 15,143 Extracardiac complications are the result of sepsis, immune complex-mediated vasculitis, and, most importantly, embolic phenomena from septic vegetations. Embolic complications may involve the cerebral, pulmonary, renal, splenic, coronary, or peripheral arteries, depending on the original locus of infection.…”

Infekcyjne zapalenie wsierdzia u dzieci — wzrastający problem

“…The risk usually rises as time goes by. IE can be a late complication of cardiac surgery for CHD, but unfortunately such a late occurrence is connected with rapid development and poor antibiotic response [9,10].…”