Hostname: page-component-848d4c4894-pftt2 Total loading time: 0 Render date: 2024-06-09T05:46:36.972Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of a structured patient education programme on early diagnosis of prosthetic pulmonary valve endocarditis

Part of: Echocardiography

Published online by Cambridge University Press:  10 November 2021

Daniela Babic ,
Ramona Hämmerli ,
Bruno Santos Lopes ,
Christine Attenhofer Jost ,
Daniel Tobler Open the ORCID record for Daniel Tobler [Opens in a new window] ,
Markus Schwerzmann ,
Barbara Hasse ,
Francesca Bonassin Tempesta  and
Matthias Greutmann Open the ORCID record for Matthias Greutmann [Opens in a new window]
Daniela Babic
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Ramona Hämmerli
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Bruno Santos Lopes
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Christine Attenhofer Jost
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Daniel Tobler
Affiliation:
Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
Markus Schwerzmann
Affiliation:
Center for congenital heart disease, University Hospital Inselspital, University of Bern, Bern, Switzerland
Barbara Hasse
Affiliation:
Division of Infectious diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Francesca Bonassin Tempesta
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
Matthias Greutmann*
Affiliation:
Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
*
Author for correspondence: M. Greutmann, MD, Department of Cardiology, University Heart Center, University of Zurich, Raemistrasse 100, 8091Zurich, Switzerland. Tel: ++41 44 255 3883; Fax: ++41 44 255 8701. E-mail: Matthias.Greutmann@usz.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes.

Methods:

A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme.

Results:

Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset of symptoms and diagnosis of infective endocarditis was 6 days (range: 0–133 days) with a significantly longer delay among patients in cohort 1, compared to cohort 2 (25 days, range: 5–133 days versus 3 days, range: 0–13 days, p < 0.0001). A delay of >7 days was documented in 11/13 patients (85%) in cohort 1 as compared to 1/13 (8%) in cohort 2 (p < 0.001). Need for urgent valve replacement or permanent deterioration of prosthetic valve function was higher in cohort 1, compared to cohort 2 (11/13, 85% versus 5/13, 39%; p = 0.041).

Conclusions:

Prosthetic pulmonary valve endocarditis is increasingly recognised. A structured patient education programme may improve early diagnosis and clinical outcomes.

Keywords

Pulmonary valve replacementinfective endocarditistetralogy of FallotRoss operation
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 10 , October 2022 , pp. 1564 - 1569
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Social Media Synopsis: Patient education leads to earlier diagnosis and improves outcomes of prosthetic pulmonary valve endocarditis: Lessons learnt from a single centre experience.

References

OʼByrne, ML, Glatz, AC, Mercer-Rosa, L, et al. Trends in pulmonary valve replacement in children and adults with tetralogy of fallot. Am J Cardiol 2015; 115: 118–124.CrossRefGoogle ScholarPubMed
Malekzadeh-Milani, S, Ladouceur, M, Iserin, L, Bonnet, D, Boudjemline, Y. Incidence and outcomes of right-sided endocarditis in patients with congenital heart disease after surgical or transcatheter pulmonary valve implantation. J Thorac Cardiovasc Surg 2014; 148: 2253–2259.CrossRefGoogle ScholarPubMed
Patel, M, Malekzadeh-Milani, S, Ladouceur, M, Iserin, L, Boudjemline, Y. Percutaneous pulmonary valve endocarditis: incidence, prevention and management. Arch Cardiovasc Dis 2014; 107: 615–624.CrossRefGoogle ScholarPubMed
Ugaki, S, Rutledge, J, Al Aklabi, M, Ross, DB, Adatia, I, Rebeyka, IM. An increased incidence of conduit endocarditis in patients receiving bovine jugular vein grafts compared to cryopreserved homograft for right ventricular outflow reconstruction. Ann Thorac Surg 2015; 99: 140–146.CrossRefGoogle ScholarPubMed
Robichaud, B, Hill, G, Cohen, S, et al. Bioprosthetic pulmonary valve endocarditis: incidence, risk factors, and clinical outcomes. Congenit Heart Dis 2018; 13: 734–739.CrossRefGoogle ScholarPubMed
Durack, DT, Lukes, AS, Bright, DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med 1994; 96: 200–209.CrossRefGoogle ScholarPubMed
Tobler, D, Schwerzmann, M, Bouchardy, J, et al. Swiss Adult Congenital HEart disease Registry (SACHER) - rationale, design and first results. Swiss Med Wkly 2017; 147: w14519.Google ScholarPubMed
Zoghbi, WA, et al. Recommendations for evaluation of prosthetic valves with echocardiography and doppler ultrasound: a report From the American Society of Echocardiography’s Guidelines and Standards Committee and the Task Force on Prosthetic Valves, developed in conjunction with the American College of Cardiology Cardiovascular Imaging Committee, Cardiac Imaging Committee of the American Heart Association, the European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography and the Canadian Society of Echocardiography, endorsed by the American College of Cardiology Foundation, American Heart Association, European Association of Echocardiography, a registered branch of the European Society of Cardiology, the Japanese Society of Echocardiography, and Canadian Society of Echocardiography. J Am Soc Echocardiogr 2009; 22: 975–1014;.CrossRefGoogle Scholar
McElhinney, DB, et al. Endocarditis after transcatheter pulmonary valve replacement. J Am Coll Cardiol 2018; 72: 2717–2728.CrossRefGoogle ScholarPubMed
Schneider, AW, et al. Long-term follow-up after the Ross procedure: a single center 22-year experience. Ann Thorac Surg 2017; 103: 1976–1983.CrossRefGoogle ScholarPubMed
Tanase, D, et al. Infective endocarditis after percutaneous pulmonary valve implantation - a long-term single centre experience. Int J Cardiol 2018; 265: 47–51.CrossRefGoogle ScholarPubMed
Cordina, R, et al. Management errors in adults with congenital heart disease: prevalence, sources, and consequences. Eur Heart J 2018; 39: 982–989.CrossRefGoogle Scholar