Villafañe Juan, Baker George Hamilton, Austin Erle H, Miller Stephen, Peng Lynn, Beekman Robert
Department of Pediatrics (Cardiology), University of Kentucky, Lexington, Kentucky.
Catheter Cardiovasc Interv. 2014 Aug 1;84(2):212-8. doi: 10.1002/ccd.25375. Epub 2014 Jan 31.
The objectives of this manuscript are two-fold: (a) to describe the clinical characteristics and management of four pediatric patients with bacterial endocarditis (BE) after Melody pulmonary valve implantation (MPVI); and (b) to review the literature regarding Melody pulmonary valve endocarditis.
There are several reports of BE following MPVI. The clinical course, BE management and outcome remain poorly defined.
This is a multi-center report of four pediatric patients with repaired tetralogy of Fallot (TOF) and BE after MPVI. Clinical presentation, echocardiogram findings, infecting organism, BE management, and follow-up assessment are described. We review available literature on Melody pulmonary valve endocarditis and discuss the prognosis and challenges in the management of these patients.
Of our four BE patients, two had documented vegetations and three showed worsening pulmonary stenosis. All patients remain asymptomatic after medical treatment (4) and surgical prosthesis replacement (3) at follow-up of 17 to 40 months. Analysis of published data shows that over half of patients undergo bioprosthesis explantation and that there is a 13% overall mortality. The most common BE pathogens are the Staphylococcus and Streptococcus species.
Our case series of four pediatric patients with repaired TOF confirms a risk for BE after MPVI. A high index of suspicion for BE should be observed after MPVI. All patients should be advised to follow lifelong BE prophylaxis after MPVI. In case of BE, surgery should be considered for valve dysfunction or no clinical improvement in spite of medical treatment.
本论文的目的有两个：(a) 描述4例接受美敦力肺动脉瓣植入术（MPVI）后发生细菌性心内膜炎（BE）的儿科患者的临床特征及治疗情况；(b) 回顾有关美敦力肺动脉瓣心内膜炎的文献。
有几篇关于MPVI后发生BE的报道。其临床病程、BE的治疗及结局仍未明确。
这是一篇多中心报告，涉及4例接受法洛四联症（TOF）修复术且术后发生MPVI后BE的儿科患者。描述了临床表现、超声心动图检查结果、感染病原体、BE的治疗及随访评估情况。我们回顾了关于美敦力肺动脉瓣心内膜炎的现有文献，并讨论了这些患者治疗中的预后及挑战。
在我们的4例BE患者中，2例有明确的赘生物，3例出现肺动脉狭窄加重。在17至40个月的随访中，所有患者经药物治疗（4例）和手术更换人工瓣膜（3例）后仍无症状。对已发表数据的分析表明，超过一半的患者接受了生物瓣膜置换，总体死亡率为13%。最常见的BE病原体是葡萄球菌和链球菌属。
我们这例包含4例接受TOF修复术儿科患者的病例系列证实了MPVI后发生BE的风险。MPVI后应高度怀疑BE。所有患者均应被告知在MPVI后需终身预防BE。如发生BE，对于瓣膜功能障碍或尽管药物治疗但无临床改善的情况，应考虑手术治疗。
