An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report
Abstract Background Native pulmonary valve (PV) infective endocarditis (IE) is a rare condition with an incidence of 1.5–2%. Although medical therapy is the mainstay of treatment, surgical intervention is still indicated in cases that fail to respond to antibiotics. To date, there is lack of consens...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-02-01
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| Series: | The Cardiothoracic Surgeon |
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| Online Access: | https://doi.org/10.1186/s43057-024-00123-3 |
| _version_ | 1797273172831109120 |
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| author | Hossameldin Hussein Ahmed Youssef Ahmed Mahgoub Noha Gamal Amr Farrag Soha Romeih |
| author_facet | Hossameldin Hussein Ahmed Youssef Ahmed Mahgoub Noha Gamal Amr Farrag Soha Romeih |
| author_sort | Hossameldin Hussein |
| collection | DOAJ |
| description | Abstract Background Native pulmonary valve (PV) infective endocarditis (IE) is a rare condition with an incidence of 1.5–2%. Although medical therapy is the mainstay of treatment, surgical intervention is still indicated in cases that fail to respond to antibiotics. To date, there is lack of consensus about the best surgical approach for isolated native PV IE. While valve repair is sometimes feasible, most of the cases require valve replacement depending on the extent of tissue damage. A stented bioprosthesis can be used when infection is confined to the valve leaflets. However, extension of damage to the pulmonary root or right ventricular outflow tract usually requires debridement and root replacement. Case presentation A 30-year-old lady with a long history of restrictive ventricular septal defect (VSD) presented with fever and shortness of breath shortly after vaginal delivery that was diagnosed as isolated PV IE with pulmonary septic emboli. After 1 week of antibiotic therapy, there was no response with persistent infection and complete valve destruction. Heart team discussion recommended PV replacement using a Freestyle valve along with VSD repair. On follow-up after 1 year, she was doing fine with well-functioning Freestyle valve. Conclusion Unrepaired restrictive VSD can be a predisposing factor for native PV IE. A Freestyle valve in the pulmonary position is a valid option for such cases, with good early outcomes and reasonable durability, particularly when there is extensive tissue infection and homograft is not available. More evidence is still required to evaluate the long-term outcomes of PV Freestyle in cases of IE. |
| first_indexed | 2024-03-07T14:40:51Z |
| format | Article |
| id | doaj.art-784e74d5386d4e86b36a6147b2da3595 |
| institution | Directory Open Access Journal |
| issn | 2662-2203 |
| language | English |
| last_indexed | 2024-03-07T14:40:51Z |
| publishDate | 2024-02-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | The Cardiothoracic Surgeon |
| spelling | doaj.art-784e74d5386d4e86b36a6147b2da35952024-03-05T20:23:55ZengSpringerOpenThe Cardiothoracic Surgeon2662-22032024-02-013211510.1186/s43057-024-00123-3An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case reportHossameldin Hussein0Ahmed Youssef1Ahmed Mahgoub2Noha Gamal3Amr Farrag4Soha Romeih5Cardiology Department, Kasr Al-Ainy Medical School, Cairo UniversityCardiac Surgery Department, Aswan Heart Centre, Magdi Yacoub FoundationCardiac Surgery Department, Aswan Heart Centre, Magdi Yacoub FoundationAdult Congenital Heart Diseases Unit, Aswan Heart Centre, Magdi Yacoub FoundationAdult Critical Care Department, Aswan Heart Centre, Magdi Yacoub FoundationAdult Congenital Heart Diseases Unit, Aswan Heart Centre, Magdi Yacoub FoundationAbstract Background Native pulmonary valve (PV) infective endocarditis (IE) is a rare condition with an incidence of 1.5–2%. Although medical therapy is the mainstay of treatment, surgical intervention is still indicated in cases that fail to respond to antibiotics. To date, there is lack of consensus about the best surgical approach for isolated native PV IE. While valve repair is sometimes feasible, most of the cases require valve replacement depending on the extent of tissue damage. A stented bioprosthesis can be used when infection is confined to the valve leaflets. However, extension of damage to the pulmonary root or right ventricular outflow tract usually requires debridement and root replacement. Case presentation A 30-year-old lady with a long history of restrictive ventricular septal defect (VSD) presented with fever and shortness of breath shortly after vaginal delivery that was diagnosed as isolated PV IE with pulmonary septic emboli. After 1 week of antibiotic therapy, there was no response with persistent infection and complete valve destruction. Heart team discussion recommended PV replacement using a Freestyle valve along with VSD repair. On follow-up after 1 year, she was doing fine with well-functioning Freestyle valve. Conclusion Unrepaired restrictive VSD can be a predisposing factor for native PV IE. A Freestyle valve in the pulmonary position is a valid option for such cases, with good early outcomes and reasonable durability, particularly when there is extensive tissue infection and homograft is not available. More evidence is still required to evaluate the long-term outcomes of PV Freestyle in cases of IE.https://doi.org/10.1186/s43057-024-00123-3Restrictive ventricular septal defectPulmonary valve infective endocarditisFreestyle valveCase report |
| spellingShingle | Hossameldin Hussein Ahmed Youssef Ahmed Mahgoub Noha Gamal Amr Farrag Soha Romeih An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report The Cardiothoracic Surgeon Restrictive ventricular septal defect Pulmonary valve infective endocarditis Freestyle valve Case report |
| title | An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report |
| title_full | An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report |
| title_fullStr | An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report |
| title_full_unstemmed | An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report |
| title_short | An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report |
| title_sort | alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect a case report |
| topic | Restrictive ventricular septal defect Pulmonary valve infective endocarditis Freestyle valve Case report |
| url | https://doi.org/10.1186/s43057-024-00123-3 |
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