Huitzilihuitl Saucedo-Orozco1, Jesús Vargas-Barrón2, Clara A Vázquez-Antona3, Francisco Castillo-Castellón4. 1. Department of Cardioneumology, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social; Mexico City-México. 2. Department of Pharmacology, Instituto Nacional de Cardiología Ignacio Chávez; Mexico City-México. 3. Department of Pediatric Echocardiography, Instituto Nacional de Cardiología Ignacio Chávez; Mexico City-México. 4. Department of Tomography, Instituto Nacional de Cardiología Ignacio Chávez; Mexico City-México.
Abstract
BACKGROUND: Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. METHODS: A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS: A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. CONCLUSIONS: Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.
BACKGROUND: Infectious endarteritis associated with patent ductus arteriosus (PDA-IE) is an uncommon complication in the era of antibiotics. However, it implies a clinical challenge in patients with a fever of undetermined origin; Two-dimensional transthoracic echocardiography (TTE) performs a fundamental role in diagnosis and follow-up. METHODS: A retrospective analysis was then made of the data of all patients admitted at our center with PDA-IE within 15 years, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. RESULTS: A total of 17 patients were identified. The mean age was 17.8 years. The TTE done in all patients confirmed the PDA and PA vegetations diagnosis; in five cases, one vegetation was present; in three cases, two vegetations were found, and in the nine remaining cases, three or more vegetations were observed. In two-thirds of the cases, the vegetations' size was 3 to 28 mm, and the principal morphology was filiform. In all cases, at least one of the vegetations was developed in the DA's lateral wall. Pulmonary valve (PV) was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in 7 cases and pulmonary aneurism in one case. CONCLUSIONS: Decreased incidence of PDA-IE has been currently achieved with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures' involvement.
Authors: J Vargas-Barron; L Avila-Rosales; A Romero-Cardenas; M Rijlaarsdam; C Keirns; A Buendia Journal: Am Heart J Date: 1992-06 Impact factor: 4.749
Authors: C A Vázquez-Antona; M Rijlaarsdam; J Gaspar; M Gil Moreno; A Buendía Hernández; M A Martínez Ríos; F Attie Journal: Arch Inst Cardiol Mex Date: 1993 Nov-Dec