Pulmonary and Aortic Valve Endocarditis in an Adult Patient With Silent Patent Ductus Arteriosus

Ozkokeli, Mehmet; Ateş, Mehmet; Uslu, Nevzat; Akcar, Murat

doi:10.1536/jhj.45.1057

Cited by 23 publications

(17 citation statements)

References 7 publications

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“…Ductal morphology was classified by Krichenko types10): type C (n=5, 25%), type D (n=12, 60%), and type E (n=3, 15%). The mean diameter was 1.7±0.6 mm (1.0 to 3.2 mm) at pulmonary end, 2.3±0.9 mm (0.9 to 4.3 mm) at the middle of ductus, and was 3.6±1.4 mm (1.2 to 6.0 mm) at aortic end.…”

Section: Resultsmentioning

confidence: 99%

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Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

et al. 2013

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PurposeThe purpose of this study was to share our experience of transcatheter closure of small patent ductus arteriosus (PDA) by using an Amplatzer vascular plug (AVP).MethodsWe reviewed the medical records of 20 patients who underwent transcatheter closure at Samsung Medical Center and Sejong General Hospital from January 2008 to August 2012. The size and shape of the PDAs were evaluated by performing angiograms, and the PDA size and the AVP devices size were compared.ResultsThe mean age of the patients was 54.9±45.7 months old. The PDAs were of type C (n=5), type D (n=12), and type E (n=3). The mean pulmonary end diameter of the PDA was 1.7±0.6 mm, and the aortic end diameter was 3.6±1.4 mm. The mean length was 7.3±1.8 mm. We used 3 types of AVP devices: AVP I (n=5), AVP II (n=7), and AVP IV (n=8). The ratio of AVP size to the pulmonary end diameter was 3.37±1.64, and AVP size/aortic end ratio was 1.72±0.97. The aortic end diameter was significantly larger in those cases repaired with AVP II than in the others (P=0.002). The AVP size did not significantly correlate with the PDA size, but did correlate with smaller ratio of AVP size to aortic end diameter (1.10±0.31, P=0.032).ConclusionTranscatheter closure of small PDA with AVP devices yielded satisfactory outcome. AVP II was equally effective with smaller size of device, compared to others.

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Section: Resultsmentioning

confidence: 99%

“…Fortescue et al7) assumed that the annual risk of infective endocarditis associated with an untreated, asymptomatic PDA would be around 0.001% to 0.01%, with approximately 0.1% of lifetime risk. After PDA closure, this risk for endocarditis decreases is reported to decrease to the risk levels experienced by the general population7,9,10).…”

Section: Discussionmentioning

confidence: 98%

Transcatheter closure of small ductus arteriosus with amplatzer vascular plug

et al. 2013

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“…Therefore, some controversy exists regarding the need for routine closure of a silent or hemodynamic irrelevant PDA for the sole purpose of eliminating the risk of PDA‐IE . In fact, the development of PDA‐IE seems to be more frequent in patients with a hemodynamic relevant PDA, while only anecdotic cases of PDA‐IE in a hemodynamic irrelevant PDA are reported . Only few reports of a PDA‐IE in young infants have been published, but due to the increasing number of very low birth weight preterms, where a PDA is a frequent finding, this infective complication has to be kept in mind.…”

Section: Discussionmentioning

confidence: 99%

“…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. As in the majority of case reports on PDA‐IE, the origin of the bacteremia was unclear in our patient.…”

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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