title: Infective endocarditis following percutaneous pulmonary valve replacement: diagnostic challenges and application of intra-cardiac echocardiography.
abstract: BACKGROUND
  Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.
  
  
  RESULTS
  This study is a retrospective review of all patients with Melody valve implantation in a tertiary centre. Between November 2006 and November 2012, 43 procedures were performed in 42 patients (mean age 25 years, 6-67 years). At a median follow-up of 27 months (2-66 months), six patients were suspected for IE. However, repeated transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) showed no evidence of IE and the patients were diagnosed as possible cases according to the modified Duke's criteria. Two patients did not respond to antibiotic treatment and underwent intra-cardiac echocardiography (ICE), which clearly demonstrated vegetations. These two cases required surgical explantation, while the other four patients were treated medically without complications.
  
  
  CONCLUSIONS
  IE after Melody valve implantation is uncommon, but difficult to verify since TTE and TEE often cannot demonstrate vegetations inside the stent. ICE should be considered in suspected cases of IE following PPVR with negative TTE and TEE examinations in order to early tailor the best treatment for the individual patient suspected for IE.
authors.affiliation: Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Gary
authors.initials: G
authors.lastname: Cheung
authors.forename: Niels
authors.initials: N
authors.lastname: Vejlstrup
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.forename: Samer
authors.initials: S
authors.lastname: Arnous
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.forename: Henning
authors.initials: H
authors.lastname: Bundgaard
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal / Q000379:methods; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011664:Pulmonary Valve / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult
keywords: Diagnosis; Infective endocarditis; Intra-cardiac echocardiography; Melody valve; Percutaneous pulmonary valve replacement