Melody® pulmonary valve bacterial endocarditis: Experience in four pediatric patients and a review of the literature

Journal Article (Review)

Objectives 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. Background There are several reports of BE following MPVI. The clinical course, BE management and outcome remain poorly defined. Methods 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. Results 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. Conclusions 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. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Full Text

Duke Authors

Cited Authors

  • Villafañe, J; Baker, GH; Austin, EH; Miller, S; Peng, L; Beekman, R

Published Date

  • August 1, 2014

Published In

Volume / Issue

  • 84 / 2

Start / End Page

  • 212 - 218

Electronic International Standard Serial Number (EISSN)

  • 1522-726X

International Standard Serial Number (ISSN)

  • 1522-1946

Digital Object Identifier (DOI)

  • 10.1002/ccd.25375

Citation Source

  • Scopus