Chronic Cardiac Conduit Masses in an Adolescent With a Right Ventricle-to-Pulmonary Artery Conduit

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Bartonella quintana infective endocarditis of a right ventricle-to-pulmonary artery conduit (n=1). Intervention: Oral doxycycline and rifampin, RV-PA conduit replacement, aortic and tricuspid vegetectomies, and renal artery pseudoaneurysm embolization. Primary outcome: Resolution of left ventricular dysfunction and clinical improvement to NYHA class I.

Geraldine Huynh; Catherine Burton; Yashu Coe; Joan  L. Robinson

doi:10.1093/cid/ciag395

June 30, 2026Clinical Infectious DiseasesOpen Access

Chronic Cardiac Conduit Masses in an Adolescent With a Right Ventricle-to-Pulmonary Artery Conduit

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Key result

Targeted antibiotics and RV-PA conduit replacement reverse LV dysfunction and restore NYHA class I in Bartonella endocarditis.

n=1

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Key Points

Identify the etiology of persistent cardiac conduit masses and recurrent pulmonary lesions in an adolescent with repaired congenital heart disease.
Evaluated a 17-year-old girl with repaired Tetralogy of Fallot and a right ventricle-to-pulmonary artery (RV-PA) conduit presenting with conduit masses, lung lesions, and purpura.
Conducted echocardiography, chest and abdominal CT imaging, standard blood cultures, infectious serologies, bronchoalveolar lavage, and nucleic acid amplification testing (NAAT) on blood and excised tissue.
Standard blood cultures showed no growth, but Bartonella serology was positive (>1:8192) and NAAT of blood and resected cardiac tissue confirmed Bartonella quintana.
The patient was treated with RV-PA conduit replacement, vegetectomies, and 12 weeks of doxycycline combined with rifampin for 6 weeks, resolving left ventricular dysfunction and improving symptoms from NYHA class III to class I.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 17-year-old female from a remote Canadian Indigenous community with repaired Tetralogy of Fallot and an RV-PA homograft conduit presenting with chronic Bartonella quintana infective endocarditis.

I

Intervention

Oral doxycycline for 12 weeks combined with oral rifampin for the first 6 weeks, alongside RV-PA conduit replacement and aortic and tricuspid vegetectomies (11 days after starting antibiotics), and renal artery pseudoaneurysm embolization (2 weeks postsurgery).

O

Outcome

Clinical improvement to NYHA class I and resolution of moderate left ventricular dysfunction following surgery and 12-week antibiotic therapy.hard clinical

Highlights that Bartonella quintana should be considered in pediatric and congenital heart disease patients with chronic culture-negative endovascular infections and nontraditional exposures like head lice, requiring serology/molecular testing, prolonged combination antibiotics, and surgical intervention.

Limitations

Pulmonary findings were not proven microbiologically to be Bartonella-related septic emboli
Uncertain role of prior rifapentine exposure for latent TB in the interval improvement of pulmonary lesions
Pulmonary lesions were not microbiologically proven to be Bartonella-related septic emboli
Uncertain role of prior 12-week isoniazid and rifapentine regimen in the interval improvement of pulmonary lesions

Implication

May support Bartonella testing and combined therapy in culture-negative conduit infections; leaves open broader validation.

Abstract

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Discussion

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Cite This Study

Huynh et al. (2026) conducted a case report in Bartonella quintana infective endocarditis of a right ventricle-to-pulmonary artery conduit (n=1). Oral doxycycline and rifampin, RV-PA conduit replacement, aortic and tricuspid vegetectomies, and renal artery pseudoaneurysm embolization was evaluated on Resolution of left ventricular dysfunction and clinical improvement to NYHA class I.

synapsesocial.com/papers/6ae35a0dc841877cc892ed6e https://doi.org/10.1093/cid/ciag395

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Chronic Cardiac Conduit Masses in an Adolescent With a Right Ventricle-to-Pulmonary Artery Conduit

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Chronic Cardiac Conduit Masses in an Adolescent With a Right Ventricle-to-Pulmonary Artery Conduit

Figures

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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