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Unexpected Endocarditis Of VSD Patch And Truncal Valve After Transcatheter Melody® Pulmonic Valve Implantation
Andrew E. Everett, MD1, Paolo Barrios, BS2, Munir Ahmed1, Tara Karamlou, MD, MSc3, Hani K. Najm, MD3.
1Cleveland Clinic Foundation, Cleveland, OH, USA, 2Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA, 3Division of Pediatric Cardiac Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.

Objective(s):
Despite early clinical success of transcatheter pulmonic valve replacement (TPVR), concerns remain for increased risk of endocarditis requiring complex reparative techniques. We present a challenging case of MSSA endocarditis of Melody® TPVR, VSD patch, and truncal valve in a 33-year old male patient status post prior repair of truncus arteriosus and subsequent re-replacement of his right ventricular pulmonary artery (RVPA) homograft conduit. Exhaustive preoperative imaging including intracardiac echo (ICE) suggested TPVR endocarditis but was otherwise inconclusive about further extent of infection.
Methods:
The surgical case above is described in detail including preoperative imaging, a high-quality narrated video, and postoperative outcome.
Results:
At surgery, extensive infection that extended from the Melody® valve to the prior VSD patch to the truncal valve via the left ventricular outflow tract (LVOT) was encountered. The prior VSD patch along with the RVPA conduit were completely extirpated and replaced. The truncal valve was replaced with a mechanical valve.
Conclusions:
This is a unique case of infection of a Melody® valve beyond the valve itself, highlighting the need for increased suspicion and surgical strategies to address multi-valve infection. It also highlights the need to be prepared for the worst case scenario when treating endocarditis.






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