Andersons pediatric cardiology 1497

Varicellazostervirusinfectionhasbeenreportedtobepotentiallycomplicated
byIE185–189inpatientswithorwithoutpreexistingheartcondition.Insomeof
thereportedcases,itmayhavefataloutcomes.
Notconfirmedinchildren.
Contrarytopreviousimpressions,childrenwithcongenitaloracquired
immunodeficienciesbutwithoutidentifiableriskfactorsforIEdonotappearto
beatincreasedriskforIE,comparedwiththegeneralpopulation.3Furthermore,
factorsoftenassociatedwithIEinadults,suchasintravenousdrugabuseand
degenerativeheartdisease,arenotcommonpredisposingfactorsinyounger
children.21,27Hemodialysisisaleadingriskfactor,especiallyforS.aureusIEin
adults,190–193butitseemsthisisnotthecaseinchildren(unpublished):this
mightberelatedtothestillrelativelymildchronicrenalfailure–relatedectopic
valvarcalcificationinchildren.
SpecificPreviousProcedureandDevice-RelatedInfective
Endocarditis.
In25%to37%ofcases,IEmaydevelopinpatientswithCHDafterprevious
cardiacoperations.130,154,194
IEonSurgicallyImplantedRV-PAConduitsandTranscatheter
PulmonaryImplantedValves.
TherehasbeenasubstantialincreaseofthenumberofsurgicalRV-PAconduits
andtranscatheterintrastentvalveimplantation.Ithasbecomeclearthatthe
bovinejugularvein(BJV)RV-PAconduits(Contegra,VenProCorporation)and
intrastentvalves(Melody,Medtronic)haveslightlyhigherfrequencyofIEas
comparedwithhomograftsandporcineheterografts.Althoughthereisno
completeexplanation,therehasbeenarecentstudyshowingincreasedbacterial
adhesionforS.aureusonBJVvalvesascomparedwithbovinepericardial
valves.195–208
ThecomparisonbetweenthereportedincidenceofIEontranscatheter
implantedMelodyvalveanddifferenttypesofsurgicallyimplantedRV-PA
conduitsispresentedinacomprehensivelistofstudiesonTable56.11.
Table56.11

InfectiveEndocarditisIncidenceonTranscatheterandSurgically


ImplantedPulmonaryValves
Reference
IEPts/Total IncidenceIE(%)
Follow-UpMedian(Min–Max)
PULMONARYTRANSCATHETERIMPLANTEDBJVMELODYVALVE
Lurzetal,2008196
5/155
3.2
0.4(0.2–1.9)
Cheungetal,2013197
6/42
14.3
2.3(0.2–5.5)
198
Buberetal,2013
14/147
9.5
1.6(0.1–5.3)
McElhinneyetal,2013199
16/311
5.1
2.5(5.1max)
200
Buteraetal,2013
2/63
3.2
2.5(1.0–4.0)

Fraisseetal,2014201
1/64
1.6
4.6(0.2–5.2)
Malekzadeh-Milanietal,2014202
5/86
5.8
1.97(0.2–2.4)
203
Cheathametal,2015
14/171
8.2
4.5(0.4–7.0)
VanDijcketal,2015204
8/107
7.5
2.0(0.3–7.8)
RV-PASURGICALLYIMPLANTEDBJVCONTEGRACONDUITS
VanDijcketal.2015204
11/53
20.4
8.8(0.7–13.5)
Albanesietal,2014205
12/106
11.3
7.6(1.7–12.7)
Ugakietal,2015206
23/244
9.4
3.2(0.1–11.7)

207
Meryetal,2016
14/245
5.7
7.0(0.02–20)
Sandicaetal,2016208
24/444
5.4
4.3±3.8
RV-PASURGICALLYIMPLANTEDCRYOPRESERVEDHOMOGRAFTS
VanDijcketal.2015204
14/517
2.4
6.5(0.1–23.7)
Ugakietal,2015206
1/135
0.7
4.3(0.1–11.6)
Meryetal,2016207
4/410
0.9
7.0(0.02–20)
208
Sandicaetal,2016
2/267
0.7
6.6±5.4
RV-PASURGICALLYIMPLANTEDDECELLULARIZEDPULMONARYHOMOGRAFTS
Sarikouchetal,2016209
0/131

0
4.59±2.76

BJV,Bovinejugularvein;IE,infectiveendocarditis;RV-PA,rightventricle-to-pulmonaryartery.

PeculiaritiesofInfectiveEndocarditisonTranscatheterImplanted
PulmonaryValves

■ThetimefromimplantationtoIEvaries:itis
possibletodevelopIEearly(1month)oratanypoint
later.
■Thecausalagentvaries:itseemsS.aureusisrarer,
andoralstreptococci,HACEKorganisms,and
Corynebacteriumspp.aredisproportionately
represented204;thereareseveralreportsofBartonella


spp.IE.210–212
■Thediagnosiscannotrelyonechocardiography
alonebecausethepositivesignofvegetationsis
relativelylow(upto50%)204;intracardiacechois
reportedasapossibility,33butitisimpracticalandCT
ispreferredasadditionalimaging.
■Acuteobstructionofthevalveisreportedasan
importantcomplicationthatmayrequireurgent
surgery.204,213,214
■Conservative-onlymanagementmightbeeffective
inupto64%.However,despitethebeliefofa
relativelylowrateofreinfection,33asignificant
proportionwilleventuallyrequiresurgery.

■IE-relatedmortalityriskvariesbetweenreports:a
recentmeta-analysiscalculateditas9.1%,215whichis
similartothepediatricIEasawhole.
InfectiveEndocarditisofAtrialSeptalDefectClosureDevices.
IEmayexceptionallyrarelyoccurafterASDAmplatzeroccluderdevice(ASO;
St.JudeMedical[SJM])implantation,relatedtoincomplete
neoendothelializationofthedevicebeyondtheexpected6monthsafterthe
procedure.Areviewpublishedin2016216summarizedatotalofsixIEcases
describedintheliterature,217–222at11monthsto4yearsaftertheprocedure,
mostlycausedbyS.aureus;thereareanadditionaltwocasespublished.223,224IE
isveryrareconsideringthissmallnumberofcasesforthemorethan300,000
devicesimplantedworldwide.Thepossibilityofincomplete
neoendothelializationofthedevicebeyond6monthsaftertheprocedureasa
predisposingfactorofIEmaybeofimportance;however,thereiscurrentlyno
methodavailabletovisualizethisfinding.
ImplantableCardiacElectronicDevice–RelatedInfective