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Tricuspid Valve Endocarditis in Four Patients with Unrepaired Restrictive Perimembranous Ventricular Septal Defects

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Abstract

Congenital heart disease (CHD) is the most common predisposing factor for pediatric infective endocarditis (IE). Although patients with unrepaired ventricular septal defects (VSDs) are at greater risk of IE than those without CHD, the American Heart Association (AHA) considers VSDs to be relatively low risk and therefore does not recommend antibiotic prophylaxis against IE. Even among patients with VSDs who develop IE, current AHA and European Society for Cardiology (ESC) guidelines do not recommend surgical VSD closure, despite the potential for a second IE event. We present a case series of four children with small, restrictive, perimembranous VSDs who developed tricuspid valve (TV) IE. All four experienced delayed diagnosis and secondary complications, including three with septic pulmonary emboli. All four patients ultimately underwent surgical VSD closure. These cases highlight the importance of recognizing IE as a possible cause of prolonged fever in children, even among those with even ‘low-risk’ CHD. The cases also draw attention to the potential benefits of VSD closure in patients who develop IE.

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Funding

No funding was provided for this case series.

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Authors and Affiliations

  1. Department of Pediatric Cardiology and Cardiothoracic Surgery, New York-Presbyterian Morgan Stanley Children’s Hospital, New York, NY, USA

    Adam M. Butensky, Alexandra Channing & David Kalfa

  2. Department of Pediatric Infectious Diseases, Stony Brook Children’s Hospital, Stony Brook, NY, USA

    Andrew S. Handel

  3. Department of Pediatric Cardiology, Stony Brook Children’s Hospital, 101 Nicolls Road, Stony Brook, NY, 11794, USA

    Stuart Holzer

Authors
  1. Adam M. Butensky
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  2. Alexandra Channing
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  3. Andrew S. Handel
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  4. David Kalfa
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  5. Stuart Holzer
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Contributions

SH and AC: Conceptualized the case series and compiled the group of patients included. AB: Performed chart review to compile the patient vignettes and drafted and revised the initial manuscript and figures. AB and AC: Reviewed patient echocardiography to select high yield images for inclusion. DK: Performed the surgeries for all of the patients included in the case series, provided surgical expertise and perspective, provided the intraoperative photograph included in the submission. AH: Provided infectious disease expertise and perspective for the case summaries and discussion. All authors reviewed and approved the final manuscript and accompanying materials as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Stuart Holzer.

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Butensky, A.M., Channing, A., Handel, A.S. et al. Tricuspid Valve Endocarditis in Four Patients with Unrepaired Restrictive Perimembranous Ventricular Septal Defects. Pediatr Cardiol 43, 1929–1933 (2022). https://doi.org/10.1007/s00246-022-02938-5

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  • DOI: https://doi.org/10.1007/s00246-022-02938-5

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