Ductus arteriosus‐associated infective endarteritis: Lessons from the past, future perspective

Abstract

Background Since routine clinical use of antibiotics as well as surgical and catheter‐based closure of a patent arterial duct (PDA), PDA‐associated infective endarteritis (PDA‐IE) is rare but can still occur when the ductus is still open or as it closes. Thus, clinicians should maintain a high index of concern for patients with unexplained fever. Methods We report on a PDA‐IE in a young infant shortly after potentially delayed obliteration of a PDA. We discuss this case report by reviewing the literature in regard to the pathogenesis (infection primary or secondary to PDA thrombus formation), clinical (new heart murmur) and diagnostic findings (transthoracic echocardiography, total body MRI, laboratory findings), and clinical outcome during mid‐term follow‐up after successful antibiotic treatment. Results A 7‐week‐old term infant with Staphylococcus aureus sepsis and a new heart murmur was diagnosed with PDA‐IE by transthoracic echocardiography at the pulmonary artery end of an obliterated PDA. Broad diagnostic workup excluded other reasons for sepsis. After 4 weeks of antibiotic treatment the vegetation reduced in size and the infant recovered completely. A review of all cases of PDA‐IE (in pediatric and adult patients) previously published was performed. Conclusion Nowadays, a PDA‐IE is an extremely rare, but still life‐threating condition that may even affect patients with a nonpatent ductus arteriosus shortly after its obliteration and should be considered as infective complication in preterms, neonates, and small infants. Therefore, in septic neonates with bacteremia, transthoracic echocardiography may be integrated in the diagnostic workup, especially by fever without source and clinical signs of IE such as a new heart murmur.

Catheter Closure of Clinically Silent Patent Ductus Arteriosus Using the Amplatzer Duct Occluder II-Additional Size: A Single-Center Experience

“…Another study reported infective endarteritis as a complication of PDA in 14 children over six years; most of these patients had small PDAs [ 11 ]. PDA-associated endarteritis is rare but can occur when the duct is still open or as it closes [ 12 ]. Patrícia Sá Ferreira et al reported an infant with Kleibsella endarteritis concerning a silent PDA [ 13 ].…”

The Patent Ductus Arteriosus in Adults with Special Focus on Role of CT

“…The risk of arterial infection endarteritis in patients with PDA has decreased because of improved dental and health care, widespread use of broad-spectrum antibiotics, and increased frequency of PDA closure using an interventional occluder device [ 1 ]. However, endarteritis can still occur, particularly with a small or silent PDA [ Figure 5 ] [ 14 , 15 , 16 , 17 , 18 , 19 ]. Turbulent flow secondary to abrupt change in diameter and pressure through the small PDA may lead to formation of endarteritis at the pulmonic end of PDA.…”

Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

“…In addition to the hemodynamic impact of the left-to-right shunt in patients with PDA, the risk of infective endocarditis (IE) is increased [3]. In the past, antibiotic IE prophylaxis (AP) was recommended in risk situations for transient bacteremia.…”