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Incidence and outcomes of prosthetic valve endocarditis in adults with tetralogy of Fallot

  • Alexander C. Egbe (a1), Srikanth Kothapalli (a1), William R. Miranda (a1), Raja Jadav (a1), Keerthana Banala (a1), Rahul Vojjini (a1), Faizan Faizee (a1), Fouad Khalil (a1), Maria Najam (a1), Mounika Angirekula (a1), Daniel C. Desimone (a2) and Heidi M. Connolly (a1)...



The risk of endocarditis varies with CHD complexity and the presence of prosthetic valves. The purpose of the study was therefore to describe incidence and outcomes of prosthetic valve endocarditis in adults with repair tetralogy of Fallot.


Retrospective review of adult tetralogy of Fallot patients who underwent prosthetic valve implantation, 1990–2017. We defined prosthetic valve endocarditis-related complications as prosthetic valve dysfunction, perivalvular extension of infection such abscess/aneurysm/fistula, heart block, pulmonary/systemic embolic events, recurrent endocarditis, and death due to sepsis.


A total of 338 patients (age: 37 ± 15 years) received 352 prosthetic valves (pulmonary [n = 308, 88%], tricuspid [n = 13, 4%], mitral [n = 9, 3%], and aortic position [n = 22, 6%]). The annual incidence of prosthetic valve endocarditis was 0.4%. There were 12 prosthetic valve endocarditis-related complications in six patients, and these complications were prosthetic valve dysfunction (n = 4), systemic/pulmonary embolic events (n = 2), heart block (n = 1), aortic root abscess (n = 1), recurrent endocarditis (n = 2), and death due to sepsis (n = 1). Three (50%) patients required surgery at 2 days, 6 weeks, and 23 weeks from the time of prosthetic valve endocarditis diagnosis. Altogether three of the six (50%) patients died, and one of these deaths was due to sepsis.


The incidence, complication rate, and outcomes of prosthetic valve endocarditis in tetralogy of Fallot patients underscore some of the risks of having a prosthetic valve. It is important to educate the patients on the need for early presentation if they develop systemic symptoms, have a high index of suspicion for prosthetic valve endocarditis, and adopt a multi-disciplinary care approach in this high-risk population.


Corresponding author

Author for correspondence: A. C. Egbe, MD, MPH, FACC, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA. Tel.: +1 507 284 2520; Fax: +1 507 266 0103; E-mail:


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1.Sabate Rotes, A, Bonnichsen, CR, Reece, CL, et al.Long-term follow-up in repaired tetralogy of Fallot: can deformation imaging help identify optimal timing of pulmonary valve replacement? J Am Soc Echocardiogr 2014; 27: 13051310.
2.Nollert, G, Fischlein, T, Bouterwek, S, Bohmer, C, Klinner, W, Reichart, B.Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997; 30: 13741383.
3.Oosterhof, T, van Straten, A, Vliegen, HW, et al.Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation 2007; 116: 545551.
4.Jones, TK, Rome, JJ, Armstrong, AK, et al.Transcatheter pulmonary valve replacement reduces tricuspid regurgitation in patients with right ventricular volume/pressure overload. J Am Coll Cardiol 2016; 68: 15251535.
5.Nishimura, RA, Otto, CM, Bonow, RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57e185.
6.Baumgartner, H, Falk, V, Bax, JJ, et al.2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38:27392791.
7.Wilson, W, Taubert, KA, Gewitz, M, et al.Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007; 116: 17361754.
8.Habib, G, Lancellotti, P, Antunes, MJ, et al.2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36: 30753128.
9.Tutarel, O, Alonso-Gonzalez, R, Montanaro, C, et al.Infective endocarditis in adults with congenital heart disease remains a lethal disease. Heart 2018; 104: 161165.
10.Kuijpers, JM, Koolbergen, DR, Groenink, M, et al.Incidence, risk factors, and predictors of infective endocarditis in adult congenital heart disease: focus on the use of prosthetic material. Eur Heart J 2017; 38: 20482056.
11.Li, JS, Sexton, DJ, Mick, N, et al.Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000; 30: 633638.
12.Zoghbi, WA, Adams, D, Bonow, RO, et al.Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30: 303371.
13.Berglund, E, Johansson, B, Dellborg, M, et al.High incidence of infective endocarditis in adults with congenital ventricular septal defect. Heart 2016; 102: 18351839.
14.Glaser, N, Jackson, V, Holzmann, MJ, Franco-Cereceda, A, Sartipy, U.Prosthetic valve endocarditis after surgical aortic valve replacement. Circulation 2017; 136: 329331.
15.Hubert, S, Thuny, F, Resseguier, N, et al.Prediction of symptomatic embolism in infective endocarditis: construction and validation of a risk calculator in a multicenter cohort. J Am Coll Cardiol 2013; 62: 13841392.
16.Anguera, I, Miro, JM, Evangelista, A, et al.Periannular complications in infective endocarditis involving native aortic valves. Am J Cardiol 2006; 98: 12541260.
17.Chan, KL.Early clinical course and long-term outcome of patients with infective endocarditis complicated by perivalvular abscess. CMAJ 2002; 167: 1924.
18.Graupner, C, Vilacosta, I, SanRoman, J, et al.Periannular extension of infective endocarditis. J Am Cardiol 2002; 39: 12041211.
19.Miranda, WR, Connolly, HM, Bonnichsen, CR, et al.Prosthetic pulmonary valve and pulmonary conduit endocarditis: clinical, microbiological and echocardiographic features in adults. Eur Heart J Card Img 2016; 17: 936943.
20.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: 22532259.
21.Thuny, F, Grisoli, D, Collart, F, Habib, G, Raoult, D.Management of infective endocarditis: challenges and perspectives. Lancet 2012; 379: 965975.


Incidence and outcomes of prosthetic valve endocarditis in adults with tetralogy of Fallot

  • Alexander C. Egbe (a1), Srikanth Kothapalli (a1), William R. Miranda (a1), Raja Jadav (a1), Keerthana Banala (a1), Rahul Vojjini (a1), Faizan Faizee (a1), Fouad Khalil (a1), Maria Najam (a1), Mounika Angirekula (a1), Daniel C. Desimone (a2) and Heidi M. Connolly (a1)...


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