Online Poster Portal

  • Author
    Elizabeth Rinaldi
  • Co-author

    Jamil Aboulhosn, MD

  • Title

    Three Episodes of Infective Endocarditis in a Patient with a Transcatheter Pulmonary Melody Valve

  • Abstract


    To present a case of three distinct episodes of infective endocarditis (IE) of a transcatheter pulmonary valve (TPV) in an adult congenital heart disease (CHD) patient.


    IE is a life-threatening infection involving a native or prosthetic cardiac valve that is a significant cause of morbidity and mortality in CHD patients. These patients are uniquely at risk for IE given their frequent histories of multiple cardiac surgeries and valve instrumentations and replacements. Additional risk factors for IE in this population include immunosuppression, high post-implant peak-to-peak valve gradient, as well as procedures and habits that induce transient bacteremia, including dental procedures, nail biting, skin picking, and animal bites.

    We report a 32-year-old male with a history of congenital bicuspid aortic valve, status post Ross procedure at age 16, which resulted in his native pulmonic valve being transposed to the aortic position and a porcine valve implanted in the pulmonic position. At age 25, the patient was implanted with a transcatheter Melody valve in the pulmonic position due to increased gradient through the porcine valve.

    Two years later, in 2015, the patient presented with a 2-week history of fevers, chills, and night sweats, and was found to have Abiotropha and Granulicatella spp. on blood cultures and septic emboli to his lung consistent with infective endocarditis of the Melody valve. Due to the patient’s complicated surgical history, the decision was made to proceed with aggressive medical management and the patient was discharged with 6 weeks of IV gentamycin/ampicillin and PO rifampin. Subsequently the patient was started on prophylactic penicillin, which he self-discontinued after several months. In 2017, the patient presented with nausea, fevers, and chills and was found to have Streptococcus Mutans bacteremia with presumed recurrent IE. He was started on a 6-week course of Ceftriaxone, after which he was again restarted on prophylactic penicillin, which the patient was subsequently compliant with. In 2021 the patient again presented with fevers, chills, and fatigue, and was found to have Streptococcus Viridans bacteremia consistent with a third episode of IE. The patient was started on IV Ceftriaxone and is now scheduled to undergo valve explantation and revision surgery after completion of his antibiotic course.  

    Throughout the time period of these events, the patient had a fairly healthy lifestyle with regular cardiology visits and did not use any alcohol, tobacco, or illicit substances, injected or otherwise. However, he had a longstanding nail-biting habit that was likely comorbid with an anxiety disorder, and he did not receive regular 6-month dental checkups and cleanings after transcatheter valve implantation as recommended. It is likely that these factors were significant contributors to his recurrent episodes of IE, especially given that the pathogens isolated in his blood cultures (Abiotrophia spp., Granulicatella spp., and Streptococcus spp.) are common components of oral bacterial flora. In addition, there has been increasing concern over the last several years that Melody valves are associated with an unacceptably high risk of IE in the CHD patient population. To prevent IE-related morbidity and mortality in patients with TPV, it is important for practitioners to be extremely vigilant of possible early signs of IE and to thoroughly educate patients and their families regarding IE risk mitigation. 

  • College


  • Zoom

  • PDF