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Incidence and outcomes of prosthetic valve endocarditis in adults with tetralogy of Fallot

Published online by Cambridge University Press:  08 January 2020

Alexander C. Egbe Open the ORCID record for Alexander C. Egbe [Opens in a new window] ,
Srikanth Kothapalli ,
William R. Miranda ,
Raja Jadav ,
Keerthana Banala ,
Rahul Vojjini ,
Faizan Faizee ,
Fouad Khalil ,
Maria Najam  and
Mounika Angirekula
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Alexander C. Egbe*
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Srikanth Kothapalli
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
William R. Miranda
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Raja Jadav
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Keerthana Banala
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Rahul Vojjini
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Faizan Faizee
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Fouad Khalil
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Maria Najam
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Mounika Angirekula
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Daniel C. Desimone
Affiliation:
Department of Internal Medicine, Mayo Clinic Rochester, Rochester, MN, USA
Heidi M. Connolly
Affiliation:
Department of Cardiovascular Medicine, Mayo Clinic Rochester, Rochester, MN, USA
*
Author for correspondence: A. C. Egbe, MD, MPH, FACC, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1 507 284 2520; Fax: +1 507 266 0103; E-mail: [email protected]
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Abstract

Background:

The risk of endocarditis varies with CHD complexity and the presence of prosthetic valves. The purpose of the study was therefore to describe incidence and outcomes of prosthetic valve endocarditis in adults with repair tetralogy of Fallot.

Methods:

Retrospective review of adult tetralogy of Fallot patients who underwent prosthetic valve implantation, 1990–2017. We defined prosthetic valve endocarditis-related complications as prosthetic valve dysfunction, perivalvular extension of infection such abscess/aneurysm/fistula, heart block, pulmonary/systemic embolic events, recurrent endocarditis, and death due to sepsis.

Results:

A total of 338 patients (age: 37 ± 15 years) received 352 prosthetic valves (pulmonary [n = 308, 88%], tricuspid [n = 13, 4%], mitral [n = 9, 3%], and aortic position [n = 22, 6%]). The annual incidence of prosthetic valve endocarditis was 0.4%. There were 12 prosthetic valve endocarditis-related complications in six patients, and these complications were prosthetic valve dysfunction (n = 4), systemic/pulmonary embolic events (n = 2), heart block (n = 1), aortic root abscess (n = 1), recurrent endocarditis (n = 2), and death due to sepsis (n = 1). Three (50%) patients required surgery at 2 days, 6 weeks, and 23 weeks from the time of prosthetic valve endocarditis diagnosis. Altogether three of the six (50%) patients died, and one of these deaths was due to sepsis.

Conclusions:

The incidence, complication rate, and outcomes of prosthetic valve endocarditis in tetralogy of Fallot patients underscore some of the risks of having a prosthetic valve. It is important to educate the patients on the need for early presentation if they develop systemic symptoms, have a high index of suspicion for prosthetic valve endocarditis, and adopt a multi-disciplinary care approach in this high-risk population.

Keywords

Tetralogy of Fallotinfective endocarditisprosthetic valve endocarditis
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 1 , January 2020 , pp. 19 - 23
Copyright
© Cambridge University Press 2020

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