Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus
Background. Infective endocarditis (IE) involving the pulmonic valve and/or the pulmonary artery is rare. An unrepaired patent ductus arteriosus (PDA) is a risk factor for IE. A previous IE is also a risk factor that predisposes to IE recurrence. Discriminating between IE recurrence and a persistenc...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-01-01
|
| Series: | Case Reports in Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2019/8268296 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832555964061974528 |
|---|---|
| author | Valerie R. Ramiro Jezreel L. Taquiso Stephanie Martha O. Obillos Charlene F. Agustin Jose Donato A. Magno Eric Oliver D. Sison |
| author_facet | Valerie R. Ramiro Jezreel L. Taquiso Stephanie Martha O. Obillos Charlene F. Agustin Jose Donato A. Magno Eric Oliver D. Sison |
| author_sort | Valerie R. Ramiro |
| collection | DOAJ |
| description | Background. Infective endocarditis (IE) involving the pulmonic valve and/or the pulmonary artery is rare. An unrepaired patent ductus arteriosus (PDA) is a risk factor for IE. A previous IE is also a risk factor that predisposes to IE recurrence. Discriminating between IE recurrence and a persistence of a vegetation from a previously treated IE can be difficult. We present the case of a 19-year-old primigravid with an unrepaired PDA and a history of IE treated 7 years prior, with positive blood cultures and vegetations on the pulmonic valve and pulmonary artery seen on transthoracic echocardiogram (TTE). Methods and Results. On TTE, a small-sized PDA with a Qp : Qs of 1.18 and vegetations on the pulmonic valve and pulmonary artery were documented. Despite the paucity of symptoms, she was empirically treated as culture-negative IE and given 2 weeks of ceftriaxone. Repeat TTE done after 2 weeks only showed a slight decrease in the vegetation size. Due to the paucity of symptoms of infection, lack of growth of the vegetation, and absence of embolic events, the vegetations were deemed to be persistent remnants from the previous IE rather than a recurrent IE. She was advised surgical PDA closure and harvest of vegetations after delivery, but the patient did not consent. The rest of her perinatal course was uneventful. Conclusion. Persistence of vegetations despite successful medical treatment occurs in some cases and has not been reported to be associated with increased morbidity. Therefore, a follow-up of IE after treatment should be guided by the clinical course and response to therapy as well as the echocardiographic morphology of vegetations over time. |
| format | Article |
| id | doaj-art-f387b2e5c74747c8bb4115d2a4c087af |
| institution | Kabale University |
| issn | 2090-6404 2090-6412 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Cardiology |
| spelling | doaj-art-f387b2e5c74747c8bb4115d2a4c087af2025-02-03T05:46:52ZengWileyCase Reports in Cardiology2090-64042090-64122019-01-01201910.1155/2019/82682968268296Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus ArteriosusValerie R. Ramiro0Jezreel L. Taquiso1Stephanie Martha O. Obillos2Charlene F. Agustin3Jose Donato A. Magno4Eric Oliver D. Sison5Section of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, PhilippinesSection of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, PhilippinesSection of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, PhilippinesSection of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, PhilippinesSection of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, PhilippinesSection of Cardiology, Department of Medicine, University of the Philippines-Philippine General Hospital, PhilippinesBackground. Infective endocarditis (IE) involving the pulmonic valve and/or the pulmonary artery is rare. An unrepaired patent ductus arteriosus (PDA) is a risk factor for IE. A previous IE is also a risk factor that predisposes to IE recurrence. Discriminating between IE recurrence and a persistence of a vegetation from a previously treated IE can be difficult. We present the case of a 19-year-old primigravid with an unrepaired PDA and a history of IE treated 7 years prior, with positive blood cultures and vegetations on the pulmonic valve and pulmonary artery seen on transthoracic echocardiogram (TTE). Methods and Results. On TTE, a small-sized PDA with a Qp : Qs of 1.18 and vegetations on the pulmonic valve and pulmonary artery were documented. Despite the paucity of symptoms, she was empirically treated as culture-negative IE and given 2 weeks of ceftriaxone. Repeat TTE done after 2 weeks only showed a slight decrease in the vegetation size. Due to the paucity of symptoms of infection, lack of growth of the vegetation, and absence of embolic events, the vegetations were deemed to be persistent remnants from the previous IE rather than a recurrent IE. She was advised surgical PDA closure and harvest of vegetations after delivery, but the patient did not consent. The rest of her perinatal course was uneventful. Conclusion. Persistence of vegetations despite successful medical treatment occurs in some cases and has not been reported to be associated with increased morbidity. Therefore, a follow-up of IE after treatment should be guided by the clinical course and response to therapy as well as the echocardiographic morphology of vegetations over time.http://dx.doi.org/10.1155/2019/8268296 |
| spellingShingle | Valerie R. Ramiro Jezreel L. Taquiso Stephanie Martha O. Obillos Charlene F. Agustin Jose Donato A. Magno Eric Oliver D. Sison Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus Case Reports in Cardiology |
| title | Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus |
| title_full | Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus |
| title_fullStr | Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus |
| title_full_unstemmed | Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus |
| title_short | Pulmonary Artery and Pulmonic Valve Vegetations in a Young Pregnant Filipino with Patent Ductus Arteriosus |
| title_sort | pulmonary artery and pulmonic valve vegetations in a young pregnant filipino with patent ductus arteriosus |
| url | http://dx.doi.org/10.1155/2019/8268296 |
| work_keys_str_mv | AT valerierramiro pulmonaryarteryandpulmonicvalvevegetationsinayoungpregnantfilipinowithpatentductusarteriosus AT jezreelltaquiso pulmonaryarteryandpulmonicvalvevegetationsinayoungpregnantfilipinowithpatentductusarteriosus AT stephaniemarthaoobillos pulmonaryarteryandpulmonicvalvevegetationsinayoungpregnantfilipinowithpatentductusarteriosus AT charlenefagustin pulmonaryarteryandpulmonicvalvevegetationsinayoungpregnantfilipinowithpatentductusarteriosus AT josedonatoamagno pulmonaryarteryandpulmonicvalvevegetationsinayoungpregnantfilipinowithpatentductusarteriosus AT ericoliverdsison pulmonaryarteryandpulmonicvalvevegetationsinayoungpregnantfilipinowithpatentductusarteriosus |