A rare late finding in corrected tetralogy of Fallot: a case report

Abstract

Introduction Isolated pulmonary valve endocarditis is a rare phenomenon. Pulmonary prosthesis endocarditis is even more unusual, with only about 50 descriptions in worldwide literature, and its diagnosis and treatment is a challenge. Due to the increasing number of surgically corrected tetralogy of Fallot (TOF) patients, that often include pulmonary valve implantation, this clinical scenario is likely to become more frequent. Case presentation We describe a 37-year-old man with a previously implanted biologic pulmonary prosthesis after a TOF correction that presented to the emergency department with new-onset fever, orthopnoea, and lower limb oedema. Blood cultures were positive for Streptococcus mitis . Transthoracic echocardiography showed a large mobile mass in the right ventricular outflow tract, apparently originating from the pulmonary prosthesis. Transoesophageal echocardiography (TOE) showed the presence of multiple mobile structures arising from the arterial surface of the prosthesis, extending into the right pulmonary artery and causing right ventricular obstruction. Antibiogram guided treatment was administered and surgery was performed, removing a 9 cm vegetation and replacing the valve. Patient recovered well and was discharged 35 days after. Discussion In right-sided endocarditis, surgery indications and its timing are much less clear than in left-sided infections, but current literature describes it as associated with a significant morbidity, mortality, and high likelihood of requiring surgery. Large vegetations and clinical signs of haemodynamic impact should prompt consideration of early surgical intervention. The combination of transthoracic and TOE allowed a correct diagnosis and a timely treatment.

Case report: right sided endocarditis in pediatric patient after surgical treatment of tetralogy Fallot

“…Large vegetations and clinical signs of haemodynamic impact should prompt consideration of early surgical intervention. 12…”

Subarachnoid Haemorrhage in a Patient With Suspected Infective Endocarditis in a District General Hospital: A Case Report-Based Literature Review

“…As such, European guidelines recommend at least 4 weeks of antibiotic therapy once cerebral haemorrhage is confirmed before performing cardiac surgery for patients with IE [ 23 , 24 ]. It is important to be aware of IE in patients with congenital defects such as Tetralogy of Fallot (TOF) and patent ductus arteriosus (PDA) and rare pulmonary prosthesis endocarditis that may present with right ventricular outflow tract obstruction (RVOT) and right heart failure [ 25 ].…”