Clinical and diagnostic features of pulmonary valve endocarditis in the setting of congenital cardiac malformations.

We studied the clinical and diagnostic features of 5 cases of pulmonary valve endocarditis where morphologic documentation was available. All patients had congenital cardiac disease as the predisposing factor and the infectious process involved only the pulmonary valve. None of the patients was addicted to drugs. Absence of systemic emboli, lack of pulmonary symptoms, acute course and high frequency of sterile cultures made the clinical recognition difficult and was possible only in three cases. The clinical picture of pulmonary valve endocarditis was characterised by fever, right-sided congestive cardiac failure and pulmonary incompetence. Echocardiography assumes a specific diagnostic role in such cases and cross-sectional echocardiography provides more information than M-mode echocardiography. Pulmonary valve endocarditis carries a high mortality and 3 patients died. Two patients underwent successful surgery of their underlying defect and excision of the pulmonary valve. Staphylococcus aureus was the organism grown from autopsy or surgical material in 3 cases.