Infectious endarteritis associated with patent ductus arteriosus and vegetation: a challenging diagnosis and treatment

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Infectious endarteritis associated with patent ductus arteriosus and vegetation (n=1). Intervention: Pulmonary angioplasty, resection of the vegetation, and ligation of patent ductus arteriosus under cardiopulmonary bypass. Primary outcome: Successful surgical treatment and postoperative recovery.

Q: What does this research mean for the field?

Surgical resection of vegetation, pulmonary angioplasty, and patent ductus arteriosus ligation successfully resolves infectious endarteritis complicated by patent ductus arteriosus. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Leizhi Ku; Youping Cheng; Xiaojing Ma

doi:10.1093/eurheartj/ehac217

April 14, 2022European Heart Journal

Infectious endarteritis associated with patent ductus arteriosus and vegetation: a challenging diagnosis and treatment

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Key result

Surgical vegetation resection, angioplasty, and PDA ligation enable successful recovery from infective endarteritis.

n=1

Why the study?

Infectious endarteritis associated with patent ductus arteriosus and vegetation presents a challenging diagnosis and treatment.

Key Points

To report the clinical diagnosis, multimodal imaging evaluation, and surgical management of infective endarteritis accompanied by a large vegetation in an adult with patent ductus arteriosus.
Evaluated a 42-year-old female presenting with 1 month of intermittent fever, continuous systolic murmur, neutrophilic leukocytosis, elevated C-reactive protein, and methicillin-susceptible Staphylococcus aureus bacteremia.
Performed transthoracic echocardiography, color Doppler flow imaging, and cardiac computed tomography angiography to characterize ductal anatomy and hemodynamic shunt parameters.
Conducted surgical resection of the vegetation, pulmonary angioplasty, and patent ductus arteriosus ligation under cardiopulmonary bypass.
Imaging identified a tubular-type patent ductus arteriosus with an aorta-to-pulmonary artery shunt velocity of 5.2 m/s, a pressure gradient of 108 mmHg, and a 1.3 × 0.8 cm vegetation on the pulmonary arterial wall.
Postoperative pathology confirmed infective endarteritis involving the pulmonary artery wall.
The patient had an uneventful postoperative recovery and achieved hospital discharge at day 7 post-surgery.

Study Design

Type

Case Report (n=1)

Structured PICO

P

Population

1 female patient (age 42 years) with patent ductus arteriosus and methicillin-susceptible Staphylococcus aureus infective endarteritis/endocarditis with a 1.3 × 0.8 cm pulmonary artery vegetation.

I

Intervention

Pulmonary angioplasty, resection of the vegetation, and ligation of patent ductus arteriosus under cardiopulmonary bypass

O

Outcome

Surgical success, histopathological confirmation of infective endarteritis, and postoperative recovery at 7 days until hospital discharge

Implication

Multimodality imaging (echocardiography and cardiac CT angiography) facilitates accurate diagnosis and successful surgical management (vegetation resection, pulmonary angioplasty, and PDA ligation) of rare adult PDA-associated infective endarteritis.

Abstract

A 42-year-old female presented with intermittent fever for 1 month. On physical examination, a continuous systolic murmur could be heard in the second left intercostal space. Laboratory test results revealed neutrophilic leucocytosis and elevated C-reactive protein levels. Blood cultures suggested positive findings of methicillin-susceptible Staphylococcus aureus, final clinical diagnosis of infective endocarditis based on modified Duke criteria. Transthoracic echocardiography showed patent ductus arteriosus (PDA) and large vegetation with the size of 1.3 × 0.8 cm attached to the pulmonary arterial wall near the orifice of the duct (Panel A). Colour Doppler flow imaging showed the shunt from the aorta to the pulmonary artery (PA), with a velocity of 5.2 m/s and a pressure difference of 108 mmHg (Panel B). Cardiac computed tomography angiography confirmed the presence of a tubular-type PDA associated with a strand-like vegetation located on the PA end of the ductus (Panels C and D). The patient underwent pulmonary angioplasty, resection of the vegetation, and ligation of PDA under cardiopulmonary bypass successfully. Postoperative pathology suggested the PA wall was associated with infective endarteritis (Panels E and F). The postoperative course was uneventful and discharged after 7 days.

Discussion

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Cite This Study

Ku et al. (2022) conducted a case report in Infectious endarteritis associated with patent ductus arteriosus and vegetation (n=1). Pulmonary angioplasty, resection of the vegetation, and ligation of patent ductus arteriosus under cardiopulmonary bypass was evaluated on Successful surgical treatment and postoperative recovery.

synapsesocial.com/papers/6ae80062d20b3f97f7a480d2 https://doi.org/10.1093/eurheartj/ehac217

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Infectious endarteritis associated with patent ductus arteriosus and vegetation: a challenging diagnosis and treatment

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Infectious endarteritis associated with patent ductus arteriosus and vegetation: a challenging diagnosis and treatment

Key Points

Study Design

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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