title: Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic features in adults.
abstract: OBJECTIVE
  To review clinical and microbiological findings in adults with prosthetic pulmonary valve (PPV) or right ventricle to pulmonary artery conduit (RVPAC) infective endocarditis (IE) and to assess the yield of transthoracic (TTE) and transesophageal echocardiography (TEE) as diagnostic tools.
  
  
  RESULTS
  Seventeen adults (age ≥18 years) with PPV/RVPAC who met diagnostic criteria for definite IE between 2000 and 2015 were included. Median age was 34 years and 29% were females; four patients (24%) had a previous episode of IE. IE occurred a median interval of 5.3 years after PPV/RVPAC insertion; median follow-up time was 206 days. The most common organisms were Staphylococcus aureus (29%), coagulase-negative staphylococci (24%), and streptococcal species (24%). Eleven patients (64.5%) required PPV/RVPAC replacement surgery as consequence of the IE episode. There were three deaths during follow-up; one non-operative and two post-operative. TTE was diagnostic for PPV/RVPAC IE in 10 (62%) and TEE was diagnostic in eight (57%) patients; when combined TTE/TEE were diagnostic in 15 of 17 (88%) cases. Severe PPV/RVPAC obstruction was present at the time of IE diagnosis in nine (53%) and severe regurgitation in five (29%).
  
  
  CONCLUSIONS
  PPV/RVPAC IE is associated with significant morbidity, mortality and high risk of requiring operative intervention. TTE and TEE are marginal diagnostic tools when used independently; they should be used as complementary techniques in the evaluation of those patients. Severe PPV/RVPAC stenosis was more common than regurgitation in patients with IE; thus IE should be considered in patients presenting with new PPV/RVPAC obstruction.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA miranda.william@mayo.edu.
authors.forename: William R
authors.initials: WR
authors.lastname: Miranda
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Heidi M
authors.initials: HM
authors.lastname: Connolly
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Crystal R
authors.initials: CR
authors.lastname: Bonnichsen
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: DeSimone
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Dearani
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Maleszewski
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.affiliation: Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Walter R
authors.initials: WR
authors.lastname: Wilson
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000328:Adult; D001705:Bioprosthesis; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D004696:Endocarditis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000401:mortality; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015996:Survival Rate; D055815:Young Adult
keywords: infective endocarditis; pulmonary valve prosthesis; right ventricular to pulmonary artery conduit