Melody pulmonary valve bacterial endocarditis: experience in four pediatric patients and a review of the literature.
OBJECTIVES
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.
['Villafañe|Juan|J|', 'Baker|George Hamilton|GH|', 'Austin|Erle H|EH|', 'Miller|Stephen|S|', 'Peng|Lynn|L|', 'Beekman|Robert|R|']
D000293:Adolescent D000900:Anti-Bacterial Agents D001705:Bioprosthesis D002648:Child D020878:Device Removal D004697:Endocarditis, Bacterial D006350:Heart Valve Prosthesis D019918:Heart Valve Prosthesis Implantation D006801:Humans D008297:Male D011474:Prosthesis Design D016459:Prosthesis-Related Infections D011664:Pulmonary Valve D011665:Pulmonary Valve Insufficiency D011666:Pulmonary Valve Stenosis D012086:Reoperation D013771:Tetralogy of Fallot D013997:Time Factors D016896:Treatment Outcome D055815:Young Adult
pulmonary valve tetralogy of fallot bioprosthetic valve complications pediatric cath/intervention infective endocarditis transcatheter pulmonary valve implantation