Infective endocarditis of the pulmonary valve following pulmonary artery catheterisation

Abstract

The risk of infective endocarditis following pulmonary artery catheterisation in patients with sepsis remains unquantified. Although catheter-induced endocardial and valvular injury are well recognised, valve infection is rare. A case of mixed pulmonary valve endocarditis associated with the use of a pulmonary artery catheter (PAC) in a patient with multisystem failure following liver trauma is described. This illustrates that diagnosis of infective endocarditis in critically ill patients can be difficult because concurrent illness and therapy may mimic or mask the usual presenting signs. The value of transoesophageal echocardiography in this context is emphasised.

Isolated Pulmonic Valve Infective Endocarditis: A Persistent Challenge

“…Cases have been documented among others, from which Streptococcus agalactiae (Group B streptococci), Lactobacillus spp., Pseudallescheria boydii, Candida albicans, and Actinobacillus actinomycetemcomitans [6,[16][17][18][19] were isolated. We have found only two previously reported cases of pulmonic valve endocarditis due to enterococci [20,21].…”

The Use of Pulmonary Artery Catheter in Sepsis Patients: A Literature Review

“…Traditional indications for PAC insertion are left ventricular dysfunction, myocardial ischemia, valvular heart disease and assessment of patients receiving vasoactive therapy like sepsis patients. However, PAC use has been associated with significant complications, including arrhythmias that usually resolve spontaneously, pneumothorax, thrombosis and hemorrhage, and case reports of pulmonary valve endocarditis have also been published [ 38 , 39 ]. When PAC is placed in situ , infections are another issue which remains of clinical importance, also distal catheter migration and pulmonary artery rupture are rare but significant complications [ 40-42 ].…”