A case of pulmonary infective endarteritis associated with patent ductus arteriosus: surgical closure under circulatory arrest

Abstract

A 35-year-old man was admitted to the hospital with prolonged high-grade fever. Chest computed tomography revealed multiple pulmonary infiltrations in both lungs, suggesting septic emboli. Echocardiography revealed patent ductus arteriosus and mobile large vegetations in the pulmonary artery. Because of uncontrollable infection and the imminent possibility of massive pulmonary embolism, he underwent transpulmonary surgical closure of the ductus and resection of the vegetations under hypothermic circulatory arrest using cardiopulmonary bypass. We report a rare case of open heart surgery in a patient with pulmonary infective endarteritis associated with patent ductus arteriosus.

Controversies in the definition and management of insignificant left-to-right shunts

“…More recent publications have recommended different management approaches. For example, many paediatric cardiologists follow patients with small ASDs regularly,2 18 and some advocate for closure of all PDAs 42 45. Not surprisingly, unnecessary follow-up and treatment have important consequences in terms of cost, human resources and parental anxiety 2 46 53 54…”

Ductus arteriosus‐associated infective endarteritis: Lessons from the past, future perspective

“…Most case reports include patients with an isolated PDA, not associated with other types of CHD or previous cardiac surgery, except one case, where the PDA‐IE involves the pulmonary valve. As in the majority of case reports on PDA‐IE, the origin of the bacteremia was unclear in our patient. Whether the mild redness of the umbilicus before hospital admission was a skin infection and therefore responsible for bacterial entrance remains open.…”

“…According to our literature review (Table ), the typical presentation of a PDA‐IE is characterized by prolonged fever (for weeks or even months), sometimes associated to clinical signs of an hemodynamic relevant PDA (fatigue, heart failure, anorexia) or of complications of a PDA‐IE such as septic pulmonary or systemic embolisms. Most case reports include patients with an isolated PDA, not associated with other types of CHD or previous cardiac surgery, except one case, where the PDA‐IE involves the pulmonary valve.…”

“…The ductus arteriosus Botalli connects the descending aortic arch with the roof of the main and left pulmonary artery and serves as an obligatory right‐to‐left shunt during fetal life. Since first successful surgical ligation of a patent ductus arteriosus (PDA) in 1938 and the establishment of medical and interventional techniques for PDA closure, infective endarteritis in patients with a PDA is a rare or even disappearing clinical entity in developed countries and only described in cases reports and one retrospective study with vegetations related to hemodynamic relevant or less relevant PDA found either in postmortem studies or echocardiographic evaluations. However, in developing countries a PDA remains a predisposing risk factor for IE …”

“…However, in developing countries a PDA remains a predisposing risk factor for IE. 27,36,37 We present the case of a 7-week-old infant with an IE (better termed as endarteritis) of the pulmonary artery at the entrance of a former PDA.…”