title: Melody pulmonary valve bacterial endocarditis: experience in four pediatric patients and a review of the literature.
abstract: OBJECTIVE
  The objectives of this manuscript are two-fold: (a) to describe the clinical characteristics and management of four pediatric patients with bacterial endocarditis (BE) after Melody pulmonary valve implantation (MPVI); and (b) to review the literature regarding Melody pulmonary valve endocarditis.
  
  
  BACKGROUND
  There are several reports of BE following MPVI. The clinical course, BE management and outcome remain poorly defined.
  
  
  METHODS
  This is a multi-center report of four pediatric patients with repaired tetralogy of Fallot (TOF) and BE after MPVI. Clinical presentation, echocardiogram findings, infecting organism, BE management, and follow-up assessment are described. We review available literature on Melody pulmonary valve endocarditis and discuss the prognosis and challenges in the management of these patients.
  
  
  RESULTS
  Of our four BE patients, two had documented vegetations and three showed worsening pulmonary stenosis. All patients remain asymptomatic after medical treatment (4) and surgical prosthesis replacement (3) at follow-up of 17 to 40 months. Analysis of published data shows that over half of patients undergo bioprosthesis explantation and that there is a 13% overall mortality. The most common BE pathogens are the Staphylococcus and Streptococcus species.
  
  
  CONCLUSIONS
  Our case series of four pediatric patients with repaired TOF confirms a risk for BE after MPVI. A high index of suspicion for BE should be observed after MPVI. All patients should be advised to follow lifelong BE prophylaxis after MPVI. In case of BE, surgery should be considered for valve dysfunction or no clinical improvement in spite of medical treatment.
authors.affiliation: Department of Pediatrics (Cardiology), University of Kentucky, Lexington, Kentucky.
authors.forename: Juan
authors.initials: J
authors.lastname: Villafañe
authors.forename: George Hamilton
authors.initials: GH
authors.lastname: Baker
authors.forename: Erle H
authors.initials: EH
authors.lastname: Austin
authors.forename: Stephen
authors.initials: S
authors.lastname: Miller
authors.forename: Lynn
authors.initials: L
authors.lastname: Peng
authors.forename: Robert
authors.initials: R
authors.lastname: Beekman
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001705:Bioprosthesis / Q000009:adverse effects*; D002648:Child; D020878:Device Removal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000382:microbiology; D011666:Pulmonary Valve Stenosis / Q000382:microbiology; D012086:Reoperation; D013771:Tetralogy of Fallot / Q000175:diagnosis / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: bioprosthetic valve; complications pediatric cath/intervention; infective endocarditis; pulmonary valve; tetralogy of fallot; transcatheter pulmonary valve implantation