Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 13:21:100591.
doi: 10.1016/j.ijcchd.2025.100591. eCollection 2025 Sep.

Evaluation of prosthetic dysfunction in the diagnosis of endocarditis associated to prosthetic pulmonary valve and pulmonary conduit

Andrés Cano Pérez  1 , Larraitz Orive Melero  1 , Jose Félix Larrea Egurbide  1 , Jagoba Larrazábal López  1 , Luis Fernández González  1 , Roberto Blanco Mata  1 , Josune Arriola Meabe  1 , Leire Artiñano Mendizábal  1 , Ane Josune Goikoetxea Agirre  2 , María José Blanco Vidal  2 , Javier Ayala Curiel  3 , Pedro María Montes Orbe  1
Affiliations

Evaluation of prosthetic dysfunction in the diagnosis of endocarditis associated to prosthetic pulmonary valve and pulmonary conduit

Andrés Cano Pérez et al. Int J Cardiol Congenit Heart Dis. .

Abstract

Introduction: The number of cases of infective endocarditis associated to prosthetic pulmonary valves and pulmonary conduits (PPVIE) is likely to increase in the future. Transthoracic echocardiography (TTE) presents challenges in visualizing lesions suggestive of endocarditis in these patients. However, TTE may provide additional findings, such as prosthetic dysfunction, which can guide the diagnosis of this condition. The main objective of this study is to analyze prosthetic pulmonary valve dysfunction as an echocardiographic manifestation of PPVIE.

Methods: All cases of PPVIE (definite and possible, according to the modified Duke criteria) at Cruces University Hospital (Baracaldo, Spain) between January 2014 and July 2024 were included. Prosthetic dysfunction was defined as a peak transvalvular gradient (PTG) ≥25 mmHg for homografts and ≥40 mmHg for prosthetic pulmonary valves and bovine pulmonary conduits (stenosis) and/or pulmonary regurgitation (PR) moderate or severe. Number of cases of prosthetic dysfunction between the PPVIE episode and prior to the episode were compared. We analyzed the mechanisms of prosthetic dysfunction in the PPVIE episode.

Results: 14 cases of PPVIE were identified. In cases prior to the PPVIE episode, 42.9 % had prosthetic dysfunction, while in the PPVIE episode, 92.3 % had prosthetic dysfunction. Stenosis was a more frequent cause of valve dysfunction than PR.

Conclusions: Prosthetic dysfunction (due to stenosis or regurgitation) is a relevant finding in the diagnosis of PPVIE in cases where lesions suggestive of endocarditis are not visualised. Although not included in the Duke criteria, stenosis is a more frequent mechanism of dysfunction than PR.

Keywords: Infective endocarditis; Prosthetic dysfunction; Pulmonary valve prosthesis; Right ventricle to pulmonary artery conduit; Transcatheter pulmonary valve; Transtorathic echocardiography.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Image 1
Graphical abstract
Fig. 1
Fig. 1
Comparison of peak transvalvular gradient (PTG) in the previous TTE and PPVIE TTE.
Fig. 2
Fig. 2
Comparison of PR in the previous TTE and PPVIE episode TTE.
Image 1
Image 1
Color doppler and peak transvalvular gradient showing a severe stenosis in a surgically implanted Biopulmonic™ prosthesis in a patient with pulmonary atresia with intact ventricular septum.
Image 2
Image 2
Color doppler and continuous doppler showing a severe pulmonary regurgitation in a Melody™ valve (in Contegra™) in a multioperated patient wit tetralogy of fallot.
Image 3
Image 3
PET-CT showing a right pulmonary embolism.
See this image and copyright information in PMC

References

    1. Mandalenakis Z., Giang K.W., Eriksson P., Liden H., Synnergren M., Wåhlander H., Fedchenko M., Rosengren A., Dellborg M. Survival in children with congenital heart disease: have we reached a peak at 97. J Am Heart Assoc. 2020;9(22) doi: 10.1161/jaha.120.017704. - DOI - PMC - PubMed
    1. Van Melle J.P., Roos-Hesselink J.W., Bansal M., Kamp O., Meshaal M., Pudich J., Luksic V.R., Rodriguez-Alvarez R., Sadeghpour A., Hanzevacki J.S., Sow R., Timóteo A.T., Morgado M.T., De Bonis M., Laroche C., Boersma E., Lancellotti P., Habib G., Habib G. Infective endocarditis in adult patients with congenital heart disease. Int J Cardiol. 2022;370:178–185. doi: 10.1016/j.ijcard.2022.10.136. - DOI - PubMed
    1. Nordmeyer J., Ewert P., Gewillig M., AlJufan M., Carminati M., Kretschmar O., Uebing A., Dähnert I., Röhle R., Schneider H., Witsenburg M., Benson L., Gitter R., Bökenkamp R., Mahadevan V., Berger F. Acute and midterm outcomes of the post-approval MELODY Registry: a multicentre registry of transcatheter pulmonary valve implantation. Eur Heart J. 2019;40(27):2255–2264. doi: 10.1093/eurheartj/ehz201. - DOI - PubMed
    1. Delgado V., Marsan N.A., De Waha S., Bonaros, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948–4042. doi: 10.1093/eurheartj/ehad193. - DOI - PubMed
    1. Miranda W.R., Connolly H.M., Bonnichsen C.R., DeSimone D.C., Dearani J.A., Maleszewski J.J., Greason K.L., Wilson W.R., Baddour L.M. Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic features in adults. Eur Heart J Cardiovasc Imaging. 2023;17(8):936–943. doi: 10.1093/ehjci/jew086. - DOI - PubMed

LinkOut - more resources