Clinical SpotlightAcute endocarditis of the patch caused by Staphylococcus capitis in treated tetralogy of Fallot. An unusual location by an unusual bacterium
Introduction
Tetralogy of Fallot represents approximately 10% of all cases of congenital heart disease (CHD) and is one of the most common cyanotic CHD [1]. Reparative surgery is usually performed within the first year [2] whereas survival to adult ages is extremely rare without palliative or corrective surgery [3]. The degree of pulmonary obstruction and pulmonary blood supply are the strongest predictors of progression of the disease. In the case of mild right ventricular obstruction and/or small ventricular septal defect and/or trivial overriding aorta, clinical presentation and rate of progression might be favourable and the unoperated patients may reach the adulthood.
However, corrective surgery in childhood [4] reduces the incidence of late complications (arrhythmias or cardiac failure) and improves long term survival although the adulthood does not increase the operative risk for corrective surgery. Postoperative care is challenging and requires a multidisciplinary team with expertise in the field of grown up CHD.
Section snippets
Clinical Summary
We present the case of 46 year-old TOF patient, HCV+, previously addicted to heroin/cocaine and currently under methadone therapy, who underwent to palliative pulmonary systemic shunt (Blalock Taussig) in 1968. Afterwards, patient was lost at follow up for low compliance due to serious psychiatric disorder. In 2010, he was referred from the drug users’ department for ECG abnormalities as follows: right atrial enlargement (tall P waves in V1), normal PR interval, enlarged QRS complex (0.12 ms)
Discussion
Un-operated TOF carries a poor prognosis (95% of patients die before 40 years of age) even in cases of previous palliative surgery [5]. In this case, long term survival should be related to the slight overriding aorta and to the previous palliative surgery even though the reasons were not completely clear.
The risk of endocarditis in TOF patients is significantly higher than in the general population and corrected TOF patients (mainly when addicted to heroin) have an exponential risk of
Conclusion
Patch endocarditis in operated TOF patients is a life-threatening complication, accounting a high rate of death. An early antibiotic treatment is mandatory to avoid diffusion, and postoperative recurrence, even though surgical treatment should be considered as soon as possible to increase patient's survival. Surgical treatment along with its main objectives (endocarditis excision and inter-ventricular shunt closure) allows a complete symptoms relief with good results in terms of morbidity and
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Surgical management of Staphylococcus capitis prosthetic valve infective endocarditis: Retrospective review of a 10-year single center experience and review of the literature
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