Infective endocarditis after transcatheter pulmonary valve implantation in patients with congenital heart disease: Distinctive features - 11/03/23

Highlights |
• | IE is a feared complication of TPVI that affects valve durability and outcomes. |
• | IE following TPVI in CHD exhibits several distinctive features. |
• | Several risk factors are associated with IE. |
• | Patient and parent education on IE prevention should be provided. |
Abstract |
The introduction of transcatheter pulmonary valve implantation (TPVI) has greatly benefited the management of right ventricular outflow tract dysfunction. Infective endocarditis (IE) is a feared complication of TPVI that affects valve durability and patient outcomes. Current recommendations provide only limited guidance on the management of IE after TPVI (TPVI-IE). This article, by a group of experts in congenital heart disease in children and adults, interventional cardiology, infectious diseases including IE, and microbiology, provides a comprehensive review of the current evidence on TPVI-IE, including its incidence, risk factors, causative organisms, diagnosis, and treatment. The incidence of TPVI-IE varies from 13–91/1000 person-years for Melody valves to 8–17/1000 person-years for SAPIEN valves. Risk factors include history of IE, DiGeorge syndrome, immunosuppression, male sex, high residual transpulmonary gradient and portal of bacteria entry. Staphylococci and streptococci are the most common culprits, whereas Staphylococcus aureus is associated with the most severe disease. In addition to the modified Duke criteria, a high residual gradient warrants a strong suspicion. Imaging studies are helpful for the diagnosis. Intravenous antibiotics guided by blood culture results are the mainstay of treatment. Invasive re-intervention may be required. TPVI-IE in patients with congenital heart disease exhibits several distinctive features. Whether specific valve types are associated with a higher risk of TPVI-IE requires further investigation. Patient and parent education regarding IE prevention may have a role to play and should be offered to all patients.
El texto completo de este artículo está disponible en PDF.Keywords : Pulmonary valve, Infective endocarditis, Congenital heart disease, Infections, Interventional cardiology
Abbreviations : CHD, IE, PET-CT, RVOT, TAVI, TEE, TPVI, TTE
Esquema
Vol 116 - N° 3
P. 159-166 - mars 2023 Regresar al númeroBienvenido a EM-consulte, la referencia de los profesionales de la salud.
