Infective endocarditis as a mid‐term complication after transcatheter aortic valve implantation

Few cases of infective endocarditis (IE) as a complication of percutaneous transcatheter aortic valve implantation (TAVI) have been reported. Here, we present a case of IE caused by Streptococcus viridans that occurred 6 months after TAVI with the corevalve revalving system. The patient was successfully treated with antibiotics and was asymptomatic during the 2 years after IE. We also present a review of the literature, including 15 published cases of IE after TAVI. © 2014 Wiley Periodicals, Inc.     

Community acquired staphylococcal pulmonary valve endocarditis in non-drug users: case report and review of the literature

Right sided endocarditis usually involves the tricuspid valve, predominantly in intravenous drug users. It is also occasionally acquired in hospital as a result of contaminated intravascular devices. Isolated infection of the pulmonary valve is rarely seen. A case of community acquired Staphylococcus aureus pulmonary valve endocarditis that caused diagnostic confusion is reported. This infection occurred in a patient with no history of intravenous drug abuse and a previously structurally normal heart.


Keywords: Staphylococcus aureus; pulmonary valve; endocarditis     

Prenatal role of the ductus arteriosus in absent pulmonary valve syndrome

Absent pulmonary valve with ventricular septal defect is associated with ductal agenesis and markedly dilated main and branch pulmonary arteries. The less common variant with intact ventricular septum generally exhibits a patent ductus and smaller branch pulmonary arteries, and may be associated with tricuspid atresia. We identified 7 patients with the prenatal diagnosis of absent pulmonary valve, 5 with ventricular septal defect (Group 1) and 2 with an intact ventricular septum (Group 2). Imaging, color Doppler, and pulsed-Doppler recordings were analyzed. The branch and main pulmonary arteries were measured and expressed as a ratio with the descending aorta. Pulmonary regurgitation time (PRT) and diastolic acceleration time (DAT) were derived, and DAT/PRT was calculated to characterize diastolic pulmonary flow. Group 1 patients all had a large ventricular septal defect, normal biventricular size and function, and dilated main and branch pulmonary arteries. Group 2 patients had dilated main but smaller branch pulmonary arteries, moderate right ventricular dilation with severe dysfunction, and limited or absent tricuspid inflow. Group 1 demonstrated shorter acceleration time and earlier peak velocity, resulting in a smaller DAT/RT ratio. We speculate that free communication between the fetal aorta and the ventricles may limit atrial inflow and elevate diastolic pressure, affecting cardiac output, ventricular function, and atrioventricular valve development. With an intact ventricular septum, these physiologic and anatomic repercussions are limited to the right ventricle, but with a ventricular septal defect, both ventricles would experience similar consequences and cardiac performance could be critically impaired.     

Implantation of a 29 mm sapien XT valve in a pediatric patient with an unstented right ventricular outflow tract

We describe a 29 mm Sapien XT valve implantation in a 10‐year‐old girl with repaired Tetralogy of Fallot, severe pulmonary regurgitation, and right ventricular dilatation, using the NovaFlex+ delivery system and the expandable introducer eSheath, without pre‐stenting of the right ventricular outflow tract. © 2015 Wiley Periodicals, Inc.     

Bioprosthetic pulmonary valve endocarditis: Incidence,risk factors,and clinical outcomes

Background: Pulmonary valve replacement (PVR) is a common operation in patients with congenital heart disease (CHD). As survival with CHD improves, infective endo‐ carditis (IE) is a growing complication after PVR. The aim of this study was to assess the incidence, risk factors, and clinical outcomes of IE after surgical PVR in patients with CHD at our institution.
Methods: Retrospective analysis of all cases of surgical PVR performed at Children’s Hospital of Wisconsin between 1975 and 2016 was performed. All cases of IE after PVR were identified and clinical and imaging data were obtained by review of medical records.
Results: Out of 924 surgical PVRs, there were 19 (2%) cases of IE. The incidence of IE after surgical PVR was 333 cases per 100 000 person‐years. The median age at diag‐ nosis of IE was 21 years (range = 1.2‐34 years) and the median time from PVR to di‐ agnosis of IE was 9.4 years. The overall freedom from IE after PVR was 99.1%, 96.9%, and 93.4%, at 5, 10, and 15 years, respectively. There was no significant difference in freedom from IE based on valve type, including bovine jugular vein grafts. Patients with IE were more likely to have had a history of multiple PVRs, while length of fol‐ low‐up after PVR, age at time of PVR, and gender were not significant risk factors. Eleven (58%) cases of IE required surgical intervention, while 8 (42%) were success‐ fully treated with intravenous antibiotics alone. There were no deaths and no recur‐ rences of IE after treatment.
Conclusion: The overall risk for IE after PVR is low. There was no association be‐ tween age or type of pulmonary valve and risk of IE. The majority of cases require surgical intervention, but in general the outcomes of IE after PVR are good with low mortality and risk of recurrence.     

Complications of pediatric cardiac catheterization: A review in the current era

Objective: To determine types of complications and risks associated with pedatric cardiac catheterization in the current era. Background: Pedatric cardiac catheterization is an important diagnostic and therapeutic tool. Although in the last decade, there have been significant improvements in technology and equipment, the risk for complications remains, adversely effecting outcomes. Design: The clinical records of 11,073 children undergoing cardiac catheterizations between January 1994 and March 2006 were reviewed to identify procedures associated with complications within the first 24 h after catheterization. All children's electronic and paper chart records were reviewed to obtain demographic, procedural, and treatment data. Results: A total of 858 (7.3%) complications (classified as major or minor) occurred in 816 studies (510 males, 63%), in children ranging in age from 8 h to 20 years (median 4.13 years). There were 195 major (22%) and 663 (78%) minor complications. Vascular complications represented the majority (n = 278; 32.4%) and were major in 53 instances (P < 0.0001). Twenty‐five children died within 24 h (0.23% of total case numbers). Independent risk factors for a complication included young patient age (<6 months), male gender, inpatient status, and year of catheterization. Conclusions: Complications continue to be associated with pedatric cardiac catheterization, although overall incidence appears to be decreasing. Patient age, gender, and inpatient status continue to be risk factors for morbidity and mortality. Efforts at improving equipment for flexibility and size, and developing strategies for the use of alternative methods for catheter access should be encouraged. © 2008 Wiley‐Liss, Inc.     

Transcatheter mitral valve thrombosis: A case report and literature review

Transcatheter mitral valve replacement (TMVR) is an exciting alternative therapy for complex patients with mitral valve disease. Experience with TMVR is new and there is a lot yet to discover about their durability, long-term outcomes, and complications including mitral transcatheter heart valve (THV) thrombosis. Many factors have been speculated to increased risk of THV thrombosis. Here, we report a case of a 72-year-old woman who developed mitral THV thrombosis after undergoing TMVR for severe mitral regurgitation with mitral annular calcification. We reviewed 42 TMVR papers with 1,484 patients, including 60 with mitral THV thrombosis. We discussed the most common strategies used for mitral THV thromboprophylaxis and treatment.     

Right‐sided endocarditis: eustachian valve and coronary sinus involvement

Infective endocarditis in patients with intravenous drug use commonly involves right‐sided heart valves. Eustachian valve (EV) endocarditis is not commonly seen given the valve's infrequent presence. Involvement of the coronary sinus (CS) with endocarditis is also an unusual finding. We present a case with echocardiographic findings consistent with EV endocarditis along with CS involvement, which appropriately responded to antibiotics.     

Simultaneous transcatheter pulmonary and tricuspid valve‐in‐valve implantation for the treatment of failing pulmonary and tricuspid bioprostheses

We report a case of a patient with a history of bioprosthetic pulmonary and tricuspid valve replacement who developed significant stenosis and regurgitation of the bioprosthetic valves. Due to multiple comorbidities, he was deemed high risk for redo‐valve replacement surgery. He subsequently underwent percutaneous transcatheter pulmonary and tricuspid valve‐in‐valve procedure at the same setting. This is the first of such that is reported in the literature. © 2015 Wiley Periodicals, Inc.     

Pseudoaneurysm after transradial cardiac catheterization: Case series and review of the literature

Introduction : Radial artery access for diagnostic and therapeutic procedures offers clear advantages in terms of vascular complications. While radial artery occlusion may occasionally complicate radial artery access, new methods of hemostasis are now utilized to avoid this complication. In contrast, pseudoaneurysm following radial artery access is an extremely uncommon complication. Methods : We describe a series of patients who developed radial artery pseudoaneurysm after their procedure. Results : Five patients developed radial pseudoaneurysm after diagnostic and interventional procedures, likely reflecting inadequate hemostasis following the procedure and delayed bleeding complicating systemic anticoagulation. Conclusions : While uncommon, radial artery pseudoaneurysm may complicate cardiac catheterization procedures, with anticoagulation an important contributor. The clinical presentation, likely precipitating mechanisms and treatment options are discussed. © 2011 Wiley Periodicals, Inc.     

Percutaneous aortic valve replacement in patients with challenging aortoiliofemoral access

Percutaneous aortic valve replacement (PAVR) offers considerable promise in treating high risk patients with aortic valve disease. Two devices are currently clinically available for transfemoral delivery: the Edwards‐Sapien balloon‐expandable bioprosthesis and the Corevalve self‐expanding bioprosthesis, both of which require careful sizing of the peripheral vasculature. Through a case based discussion, we illustrate that these limits of PAVR technology can be stretched in cases of extraordinary clinical need. We demonstrate that, following a learning curve of “optimal cases,” successful PAVR is also possible in diffusely diseased peripheries of borderline small size or with focal aortoiliofemoral disease amenable to a separate intervention beforehand. © 2008 Wiley‐Liss, Inc.     

Transcatheter mitral valve‐in‐valve implantation in a pediatric patient

An 11‐year‐old girl, with 25 mm mosaic tissue valve presented with clinical and echocardiographic appearance of stenotic mitral valve prosthesis. Her condition was treated via a transcatheter valve‐in‐valve implantation using a 23 mm Edwards Sapien 3, with satisfactory outcome.