Endocarditis Complicating Parenteral Nutrition: The Value of Repeated Echocardiography

Abstract

Cardiac complications of parenteral nutrition are well recognized but the diagnosis of such complications may be difficult. Two-dimensional echocardiography has been shown to be of value in establishing the diagnosis of valvular vegetations and right atrial thrombus. We describe two patients who developed endocarditis while receiving parenteral nutrition via central venous catheters. In both cases initial echocardiography was normal and the tricuspid valvular vegetations were only picked up after one or more additional echocardiograms. This highlights the necessity for repeated echocardiography in patients receiving parenteral nutrition in whom infective central venous catheter complications fail to resolve quickly after appropriate treatment.

Outpatient Parenteral Antimicrobial-Drug Therapy

“…Trauma to the valve results in platelet-fibrin thrombi that can be infected during transient bacteremia. 55,56 The risk of infection is increased as the diameter of the catheter, 23-26 the adhesive properties of the catheter, and the slime production by specific organisms increase. [57][58][59][60][61] The composition of the catheter is important.…”

Endocarditis with a large thrombus complicating a central venous access device

“…3 They described two patients in whom the initial echocardiograms were normal and the tricuspid valvular vegetations were identi® ed only after one or more additional echocardiograms. Although transoesophageal echocardiography provides excellent images of intracardiac masses, it is seldom required in infants and young children in whom transthoracic echocardiography gives good visualization of the intracardiac structures.…”