Isolated Pulmonic Valve Endocarditis

Abstract

Patient: Male, 47Final Diagnosis: Pulmonic valve endocarditisSymptoms: Fever • myalgiaMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Rare diseaseBackground:Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided endocarditis is in itself rare, with some studies reporting an incidence of 5–10%. The majority of these cases involve the tricuspid valve, and isolated pulmonary valve endocarditis (PVE) is an extremely rare entity affecting less than 2% of patients with infective endocarditis. Identification and early management are crucial to prevent long-term complications and reduce mortality.Case Report:We present a patient with a history of essential hypertension and no underlying valvular disease, who underwent dental cleaning and subsequently developed low-grade fever, myalgia, and malaise. This occurred during the flu season, and was initially diagnosed and treated as flu, without any improvement. The patient was later found to be bacteremic with S. mitis, with no identifiable source, and a normal transthoracic echocardiogram (TTE). He was later hospitalized, had a transesophageal echocardiogram, and was found to have a large pulmonic valve vegetation.Conclusions:This case presents an interesting and rare finding of endocarditis, isolated to the pulmonic valve, in an otherwise healthy individual with no predisposing risk factors. The lack of peripheral stigmata, as well as an unremarkable initial outpatient TTE, made the diagnosis more difficult. It should also be noted that current guidelines do not specifically address right-sided endocarditis, and do not specify the role of surgical intervention.

AngioVac Removal of an Isolated Infected Pulmonary Valve Papillary Fibroelastoma

“…Surgical excision of left-sided PFE is advised, but there is less consensus on the management of right-sided PFE. Isolated pulmonic valve endocarditis is a rare entity, as well, affecting <2% of patients with infective endocarditis ( 4 ). Differentiating between these 2 options is only possible with surgical pathology and culture.…”

Isolated Pulmonary Valve Endocarditis

“…Even though the sensitivity of TTE is high (40%-63%), normal valvular imaging and function do not exclude the suspicion of endocarditis. In this situation, TEE is performed which has higher sensitivity (90%-100%) in detecting vegetations and valvular abscesses [ 8 - 9 ]. As discussed above in our case, the initial TTE failed to reveal any pulmonary valve abnormality even though anatomically speaking the pulmonary valve is closer to the chest wall.…”

Unexpected isolated native pulmonary valve endocarditis; really benign as thought?

“…4 A structurally normal pulmonary valve is unlikely to be affected on its own. [8][9][10][11][12] Pulmonary valve experiences less shear stress than other valves due to a lower transvalvular pressure gradient. This results in less risk for a valvular injury and protects the pulmonary valve against IE.…”

“…[4][5][6][7][8][9] Although most patients with PVE have been shown to respond well to appropriate antibiotic therapy, the role and timing of surgical therapy are not clear. 3,4,11,12 In general, persistent bacteremia or increased vegetation size (>2 cm) despite antibiotic therapy, recurrent embolism, severe pulmonary valve dysfunction secondary to valve destruction, and right heart failure are candidates for surgery. 5,7,[13][14][15] According to previous data, 15%-30% of patients have required surgery, 14 but in the case series of 24 PVE by Isaza et al 5 between 2002 and 2018, surgery was required in the majority of patients (75%), particularly those with prosthetic PVE.…”