Surgical case of isolated pulmonary valve endocarditis in a patient without predisposing factors

Abstract

We report a case of isolated pulmonary valve endocarditis in a 47-year-old woman without predisposing factors. She had episodes of low-grade fever and non-productive cough and was initially diagnosed with bacterial pneumonia. With antibiotic treatment, her condition improved transiently, but she had repeated respiratory events. Forty days after her first visit, she complained of severe dyspnea. Echocardiography revealed a large vegetation adhering to the pulmonary valve and she was diagnosed with isolated pulmonary valve endocarditis. Surgical treatment was selected because antibiotic treatment was not effective. The main pulmonary artery was transected above the annulus and the infected valve was excised. To avoid contact of the prosthetic valve with the infected pulmonary annulus, a stentless bioprosthesis was interposed between the transected parts of the pulmonary trunk. Two years after the surgery, the patient is stable with no sign of infection.

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

“…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 5,7,13–15 . 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.…”

“…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 5,7,13–15 . 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. They also showed that patients with congenital heart diseases had a better prognosis than others with PVE.…”