Echocardiographic findings in patent ductus arteriosus-associated infective endarteritis

Özet

Objective: 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) plays a fundamental role in diagnosis and follow-up. Methods: A retrospective analysis of the data of all patients admitted to our center with PDA-IE within 15 years was conducted, and a review of the literature regarding diagnosis, TTE findings, and treatment was performed. Results: A total of 17 patients were identified with a mean age of 17.8 years. TTE done in all patients confirmed the diagnosis of PDA and pulmonary artery vegetation. In five patients, one vegetation was present; in three patients, two vegetations were found; and in the nine remaining patients, three or more vegetations were observed. In two-thirds of the patients, the size of the vegetation was three to 28 mm, and the principal morphology was filiform. In all patients, at least one vegetation developed on the lateral wall of the ductus arteriosus. Pulmonary valve was affected in 41% of the patients and caused low to moderate valvular regurgitation. Pulmonary embolism was present in seven patients and pulmonary aneurysm in one patient. Conclusion: The incidence of PDA-IE has decreased in the recent years with early antibiotic therapy. However, today, this complication carries a significant risk of valve damage and other cardiac structures’ involvement.