Patent ductus arteriosus endarteritis in a 40-year old woman, diagnosed with Transesophageal Echocardiography. A case report and a brief review of the literature

Kouris, Nikos T.; Sifaki, Maria; Kontogianni, Dimitra D.; Zaharos, I; Kalkandi, E; Grassos, H. E.; Babalis, Dimitris

doi:10.1186/1476-7120-1-2

Cited by 12 publications

(13 citation statements)

References 16 publications

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“…In accordance to our S. aureus bacteremia, bacterial pathogens for PDA‐IE are mainly Streptococcus spp. , Staphylococcus spp., and very rarely Gram‐negative rods . Our echocardiographic findings of a hyperechogenic structure in the parasternal short‐axis view in the original shunt flow direction of the PDA are also typical findings due to endothelial lesions surrounding the opening of the PDA on the left pulmonary artery as the predisposing pathogenic factor of an IE .…”

Section: Discussionsupporting

confidence: 61%

“…19 Therefore, some controversy exists regarding the need for routine closure of a silent or hemodynamic irrelevant PDA for the sole purpose of eliminating the risk of PDA-IE. 1,37 In fact, the development of PDA-IE seems to be more frequent in patients with a hemodynamic relevant PDA, [3][4][5][6][7][8][9][10][11][12][13][14][15]18,19 while only anecdotic cases of PDA-IE in a hemodynamic irrelevant PDA are reported. 11,16,24,29,38,39 Only few reports of a PDA-IE in young infants have been published, 15,19,29,39 but due to the increasing number of very low birth weight preterms, where a PDA is a frequent finding, this infective complication has to be kept in mind.…”

Section: Discussionmentioning

confidence: 99%

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

Callegari

Burkhardt

Relly

et al. 2019

Congenital Heart Disease

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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.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

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

Callegari

Burkhardt

Relly

et al. 2019

Congenital Heart Disease

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“…They cited an annual incidence of IE in PDA of 0.14% (binomial 95% CI: 0.05–0.5%). More recently, between 2002 and 2008, five case reports have been published describing IE in patients with an isolated PDA, as summarized in Table 3 45–49 . Each of these reports emphasizes the importance of a high index of suspicion of IE in a patient with a known PDA who presents with prolonged symptoms of systemic infection.…”

Section: Ie In Association With a Pdamentioning

confidence: 99%

“…More recently, between 2002 and 2008, five case reports have been published describing IE in patients with an isolated PDA, as summarized in Table 3. [45][46][47][48][49] Each of these reports emphasizes the importance of a high index of suspicion of IE in a patient with a known PDA who presents with prolonged symptoms of systemic infection. They also illustrate the sensitivity of echocardiography in making the diagnosis of PDA in such patients.…”

Section: Ie In Association With a Pdamentioning

confidence: 99%

To Close or Not to Close: The Very Small Patent Ductus Arteriosus

Fortescue

Lock

Galvin

et al. 2010

Congenital Heart Disease

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Patent ductus arteriosus (PDA) accounts for approximately 10% of all congenital heart diseases, with an incidence of at least 2–4 per 1000 term births. Closure of the large, hemodynamically significant PDA is established as the standard of care, and can be performed safely and effectively using either surgical or transcatheter methods. The appropriate management of the very small, hemodynamically insignificant PDA is less clear. Routine closure of such defects has been advocated to eliminate or reduce the risk of infective endocarditis (IE). However, the risk of IE in patients with a small PDA appears to be extremely low, and IE is treatable. Although closure of the small PDA is generally safe and technically successful, it is unknown whether this treatment truly improves the risk : benefit balance compared with observation. In this article, we review the published literature on the natural history and treatment outcomes in individuals with a PDA, the epidemiology and outcomes of IE, particularly in association with PDA, and the rationale and evidence for closure of the very small PDA.

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“…Fatigue, dyspnea, palpitations, and exercise intolerance are the most common symptoms. If associated complications like infective endocarditis, pulmonary hypertension, and congestive heart failure develop, complication related signs and symptoms may be seen [3,4]. In any clinical suspicion, transthoracic echocardiography should be performed as initial diagnostic testing.…”

Section: Discussionmentioning

confidence: 99%