Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies

Abstract

Infective endocarditis (IE) is a disease of the endocardium, which leads to the appearance of vegetation on the valves, cardiac structures, or, potentially, vascular endothelium of the heart. The risk of IE can be increased more than 140 times by congenital heart disease (50–59% of all IE), particularly if cyanotic. An increase in mortality may result from IE in patients with a complex cardiac pathology or patients with an implanted prosthetic material, most frequently conduits in a pulmonary position. Cardiac implantable electronic devices (CIED) infective endocarditis is a life-threatening complication representing 10% of all cases of endocarditis. Common signs of presentation are often fever and chills; redness and swelling at the pocket of the pacemaker, including the erosion and exteriorization of the device; and life-threatening sepsis. The use of intracardiac echocardiography for the diagnosis of IE is an innovative method. This may be needed, especially in older children undergoing complex cardiac surgery, when transthoracic echocardiography (TTE) and transesophageal echocardiography (TOE) failed to provide a reliable diagnosis. The 2018 European Heart Rhythm Association (EHRA) experts’ consensus statement on transvenous lead extraction recommends complete device removal and antimicrobial therapy for any device-related infection, including CIED-IE. The most detected microorganism was Staphylococcus Aureus. In addition, cardiac surgery and interventional cardiology associated with the placement of prostheses or conduits may increase the risk of IE up to 1.6% for Melody valve implantation. Our manuscript presents a comprehensive review of infective endocarditis associated with cardiac devices and prostheses in the pediatric population, including recent advances in diagnosis and management.

Mitral valve replacement in children: balancing durability and risk with mechanical and bioprosthetic valves

“…Bioprosthetic valves on the other hand avoid the need for anticoagulation but are associated with accelerated calcification leading to failure and early reoperation, especially in young children [ 14 ]. It is also crucial to highlight the significant risk of endocarditis associated with bioprosthetic valves, especially following Melody valve implantation [ 13 ].…”

Data Analysis of Biomechanical Dynamic Modeling of a Prosthetic Running Blade

“…In prosthetic running blades, explicit dynamic modeling emerges as a pivotal tool, enabling a deeper understanding of the complex biomechanical interactions. This approach is particularly relevant in the context of high-impact activities such as running, where the prosthetic must not only replicate but also enhance the natural movement of the human body (Al-Fareh et al, 2023;Dardari et al, 2023;Mohd Mukhtar et al, 2023;Murawa et al, 2023;Seratiuk Flores et al, 2023;Sidhu et al, 2023). The explicit dynamic modeling of a prosthetic running blade involves simulating the real-time physical behaviors of the blade under various conditions, such as different speeds, angles of impact, and forces.…”