A Case with Patent Ductus Arteriosus Complicated by Pulmonary Artery Endarteritis

Choi, Kyu-Nam; Yang, Tae–Hyun; Park, Bong Soo; Jun, Haejung; Lim, Soo-Jung; Seol, Sang–Hoon; Kim, Seong-Man; Kim, Dae-Kyeong; Kim, Doo-Il; Kim, Dong-Soo

doi:10.4250/jcu.2008.16.3.90

Cited by 9 publications

(13 citation statements)

References 12 publications

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“…They cited an annual incidence of IE in PDA of 0.14% (binomial 95% CI: 0.05–0.5%). More recently, between 2002 and 2008, five case reports have been published describing IE in patients with an isolated PDA, as summarized in Table 3 45–49 . Each of these reports emphasizes the importance of a high index of suspicion of IE in a patient with a known PDA who presents with prolonged symptoms of systemic infection.…”

Section: Ie In Association With a Pdamentioning

confidence: 99%

“…More recently, between 2002 and 2008, five case reports have been published describing IE in patients with an isolated PDA, as summarized in Table 3. [45][46][47][48][49] Each of these reports emphasizes the importance of a high index of suspicion of IE in a patient with a known PDA who presents with prolonged symptoms of systemic infection. They also illustrate the sensitivity of echocardiography in making the diagnosis of PDA in such patients.…”

Section: Ie In Association With a Pdamentioning

confidence: 99%

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To Close or Not to Close: The Very Small Patent Ductus Arteriosus

Fortescue

Lock

Galvin

et al. 2010

Congenital Heart Disease

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Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2–4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk : benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.

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Section: Ie In Association With a Pdamentioning

confidence: 99%

Section: Ie In Association With a Pdamentioning

confidence: 99%

To Close or Not to Close: The Very Small Patent Ductus Arteriosus

Fortescue

Lock

Galvin

et al. 2010

Congenital Heart Disease

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“…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.…”

Section: Discussionmentioning

confidence: 72%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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 …”

Section: Introductionmentioning

confidence: 99%

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

Callegari

Burkhardt

Relly

et al. 2019

Congenital Heart Disease

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Background Since routine clinical use of antibiotics as well as surgical and catheter‐based closure of a patent arterial duct (PDA), PDA‐associated infective endarteritis (PDA‐IE) is rare but can still occur when the ductus is still open or as it closes. Thus, clinicians should maintain a high index of concern for patients with unexplained fever. Methods We report on a PDA‐IE in a young infant shortly after potentially delayed obliteration of a PDA. We discuss this case report by reviewing the literature in regard to the pathogenesis (infection primary or secondary to PDA thrombus formation), clinical (new heart murmur) and diagnostic findings (transthoracic echocardiography, total body MRI, laboratory findings), and clinical outcome during mid‐term follow‐up after successful antibiotic treatment. Results A 7‐week‐old term infant with Staphylococcus aureus sepsis and a new heart murmur was diagnosed with PDA‐IE by transthoracic echocardiography at the pulmonary artery end of an obliterated PDA. Broad diagnostic workup excluded other reasons for sepsis. After 4 weeks of antibiotic treatment the vegetation reduced in size and the infant recovered completely. A review of all cases of PDA‐IE (in pediatric and adult patients) previously published was performed. Conclusion Nowadays, a PDA‐IE is an extremely rare, but still life‐threating condition that may even affect patients with a nonpatent ductus arteriosus shortly after its obliteration and should be considered as infective complication in preterms, neonates, and small infants. Therefore, in septic neonates with bacteremia, transthoracic echocardiography may be integrated in the diagnostic workup, especially by fever without source and clinical signs of IE such as a new heart murmur.

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Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report

Thoen

Moreel²,

Adriaenssens³

et al. 2020

ESC Heart Failure

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Patients with adult congenital heart disease are born with structural heart defects who survived into adulthood. Occasionally, complex lesions remain undiagnosed, potentially causing substantial cardiovascular health problems at young age. Here, the case is presented of a patient with subacute heart failure 1 week postpartum, revealing the diagnosis of aortic coarctation (CoA) with patent ductus arteriosus (PDA). A 34-year-old woman presented to the emergency department with severe hypertension and exercise-related dyspnoea 1 week postpartum. An initial diagnosis of pulmonary embolism was made after detection of a solitary opacity in the pulmonary artery (PA) on CT pulmonary angiography. Symptoms persisted despite anticoagulant treatment. Thorough clinical and echocardiographic reassessment unmasked the diagnosis of severe CoA with PDA, which was treated with percutaneous dilatation and stenting. Follow-up consultation 4 weeks later showed an asymptomatic patient with normalized blood pressure. The puerperium is a high-risk period to develop hypertensive heart failure for mothers with pre-existing heart disease, due to mobilization of extracellular fluid to the intravascular compartment. Undiagnosed CoA should always be ruled out in case of unexplained postpartum hypertension. When detecting a solitary opacity in the PA, a PDA with associated heart defects should be excluded by further investigations. This opacity is located at the orifice of the PDA in the PA and is probably a flow effect, which results from the mix of contrast-free with contrast-rich blood.

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A Case with Patent Ductus Arteriosus Complicated by Pulmonary Artery Endarteritis

Cited by 9 publications

References 12 publications

To Close or Not to Close: The Very Small Patent Ductus Arteriosus

To Close or Not to Close: The Very Small Patent Ductus Arteriosus

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

Undiagnosed adult congenital heart disease presenting with postpartum dyspnoea: a case report

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