Elevated Pressure Gradient of the Right Ventricular Outflow Tract in Infective Endocarditis - A Possible New Major Duke Criteria
2Pediatric heart institute, Schneider Children Medical Center, Petach Tikva
3Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
Objective: Right ventricular outflow tract (RVOT) infective endocarditis (IE) in children occurs mainly in patients with an exogenous conduit, which presents challenge in vegetations visualization. We examined the added value of an elevated RVOT pressure gradient on the diagnosis of IE.
Methods: Retrospective cohort study conducted between 2000-2020 at a single tertiary children`s medical center. Diagnosis of IE was confirmed based on modified Duke criteria. All patients with RVOT IE were evaluated. Data on clinical, laboratory and echocardiographic findings including RVOT pressure gradient were retrieved from the patients` files.
Results: A total of 8 patients were included, 7 males and 1 female. Median age at diagnosis of IE was 13.75 years (IQR 1.9-16.1). Congenital heart defects included: tetralogy of Fallot (5 patients), truncus arteriosus, transposition of the great arteries, and congenital pulmonic stenosis (one patient each). Patients were implanted with either homograft, Jugograft, Contegra or Melody valve. RVOT pressure gradient at admission with IE was elevated in all patients. Median RVOT gradient during the 6 months prior to diagnosis was 36 mm Hg (IQR 24.5-50.5), and at time of diagnosis 70 mm Hg (IQR 42.25-100), p=0.0271. Diagnosis based on Duke criteria was definite in 5/8 patients. When considering elevated RVOT pressure gradient as a major Duke criterion, all 3 patients with possible diagnosis of IE became definite at admission.
Conclusions: Elevated RVOT pressure gradient is a possible marker for infective endocarditis in patients with pulmonary valve implantations, allowing definite diagnosis in debatable cases, when regarded as a major Duke criterion.