Case report: Transcatheter pulmonary valve-in-valve implantation in a deteriorated self-expandable valve caused by infective endocarditis

Abstract

BackgroundInfective endocarditis is a complication with high mortality in patients with congenital heart disease, particularly for those with bioprosthetic valve.Case summaryWe report a case of a 54-year-old female with a history of tetralogy of Fallot who had been surgically repaired using a transannular patch due to severe pulmonary insufficiency with right heart enlargement and presented with worsening dyspnea. She had received transcatheter pulmonary valve implantation (TPVI) 5 years ago. Unfortunately, bioprosthesis-associated infective endocarditis occurred due to dental caries. Given persistent antibiotic medication, she became clinically stable with prosthesis functional recovery. However, dysfunctional bioprosthesis was still detected 3 years later, which was successfully treated by valve-in-valve TPVI with the help of modified buddy wire technique. At a 12-month follow-up after valve-in-valve TPVI, she was completely recovered with improved symptoms of heart failure.ConclusionThis is the first report of valve-in-valve TPVI of a self-expandable valve in a degenerated self-expandable valve. The case highlights increased surveillance for infective endocarditis of transcatheter pulmonary valve should be emphasized. Subsequent valve-in-valve TPVI is an effective treatment for valve failure in defined conditions improving the hemodynamics.

Five‐year follow‐up after percutaneous pulmonary valve implantation using the Venus P‐valve system for patients with pulmonary regurgitation and an enlarged native right ventricular outflow tract

“…The survival rate from endocarditis was estimated as 91% in this study, relatively lower than in previous studies with Harmony valves (100%) 13 . The final occurrence of endocarditis in our study was reported at 5 years after implantation 16 . But a different finding was demonstrated according to the intermediate‐term follow‐up data of the international Venus P‐valve database outside China as no imaging or laboratory evidence of endocarditis were detected 10 .…”

“…13 The final occurrence of endocarditis in our study was reported at 5 years after implantation. 16 But a different finding was demonstrated according to the intermediateterm follow-up data of the international Venus P-valve database outside China as no imaging or laboratory evidence of endocarditis were detected. 10 The high incidence of endocarditis in our study might be attributed to the lack of strict clinical practice in performing antibiotic prophylaxis following surgery and percutaneous procedures, including PPVI, in China.…”