Left Coronary Artery Compression and Stent Fracture Following Self-Expanding Transcatheter Pulmonary Valve Implantation.

Coronary compression and vascular perforation have not been reported for self-expanding transcatheter pulmonary valves. We describe a patient with tetralogy of Fallot after self-expanding valve implantation who developed left coronary artery compression from the valve. In addition, a wire frame fracture resulted in perforation of the aorta.

Transhepatic Transcatheter Pulmonary Valve Replacement.

Transcatheter pulmonary valve replacement (TPVR) is complicated in patients without adequate femoral or internal jugular vascular access. Transhepatic vascular access has been shown to be safe and effective across a spectrum of diagnostic and interventional procedures. Closure of the hepatic venous tract can be accomplished with a multitude of readily available vascular occlusion devices. The rates of major adverse events are low: 5% to 8% with hemoperitoneum and complete heart block are most significant. To our knowledge, this is the first report of using transhepatic access for TPVR; closure of the hepatic venous tract was achieved with an Amplatzer vascular plug type II.

Isolated Pulmonic Valve Endocarditis: A Rare Clinical Entity.

Background: Isolated pulmonic valve endocarditis is a rare heart valve infection, and constitutes about 1% to 2% of all infective endocarditis cases. Modified Duke's criteria were used to diagnose culture negative pulmonic valve endocarditis. Case presentation: A 52-year-old male patient presented with generalized body swelling of 1 month duration associated with prolonged fever, malaise, fatigue, and lassitude. He had productive cough, dyspnea on mild exertion, and reddish discoloration of urine. Upon physical examination, blood pressure (BP) = 140/90 mmHg, pulse rate (PR) = 104 beats per minute, respiratory rate (RR) = 26 breaths per minute, temperature (T0) = 38.3°C, and Sp02 = 90% at ambient air. He had signs of bilateral pleural effusion. Cardiovascular examination revealed tachycardia, raised jugular venous pressure, murmurs of pulmonic regurgitation, and tricuspid regurgitation. There was grade 2 ascites and bilateral leg edema. On laboratory investigation, there were normochromic, normocytic anemia; raised ESR; positive Rheumatoid factor, elevated serum creatinine; and active urinary sediments on urinalysis. Two sets of blood culture were negative on days 1, 5, and 7. Chest-X-ray showed cardiomegaly with bilateral pleural effusion. ECG revealed sinus tachycardia with regular P-waves and QRS complexes. 2D Transthoracic echo showed vegetation on pulmonic valves, pulmonary valve lesions, dilated right atrium and right ventricle, and elevated right ventricular systolic pressure. Abdominal ultrasound revealed enlarged and echogenic kidneys, and ascites. Definitive diagnosis of PVE was made using modified Duke's criteria which was evidenced by 1 major (echo-proven vegetation on pulmonic valve), and 3 minors (suspected congenital pulmonic stenosis, fever, and immunologic phenomena [acute glomerulonephritis, positive rheumatoid factor]). The patient's clinical condition markedly improved after 2 weeks of intravenous antibiotics and loop diuretics, and discharged home after completing 6 weeks of parenteral antibiotics. Conclusion: Modified Duke's criteria could play a major role in the management decision about diagnosis and empiric treatment of infective endocarditis in the absence of positive bacterial cultures.

Pulmonic valve fibroelastoma-A rare incidental finding.

Primary cardiac neoplasms are a rare, commonly benign, tumor with an approximate incidence rate of 0.02%. Papillary fibroelastoma (PFE), a common form of primary cardiac neoplasms, typically present as a mass on the aortic and mitral valves, while rarely presenting as a pulmonary valve tumor. The majority of PFEs are asymptomatic, however valvular masses can pose a significant health hazard due to their potential to fragment into the bloodstream, facilitate thrombus formation, and restrict blood flow. Due to these risks, careful resection of the mass is recommended for symptomatic patients and asymptomatic patients if the tumor is large (>1 cm), mobile, or on left-sided valves. Here we present a case of an incidental finding of a pulmonic valve papillary fibroelastoma in a 65-year-old man by transesophageal echocardiography during a coronary artery bypass graft procedure.

Retrieval of Large Balloon Fragments During Transcatheter Pulmonary Valve Implantation Using a Novel Retrieval System.

The removal of balloon fragments from the pulmonary artery without damaging the pulmonary and tricuspid valves can be difficult. Four cases during transcatheter pulmonary valve replacement are described in which a novel retrieval system was used to facilitate safe removal. (Level of Difficulty: Advanced.).

Possible Isolated Pulmonic Valve Endocarditis in a Patient With Sickle Cell Disease: A Case Report.

Pulmonic valve endocarditis is a rare and clinically elusive identity, commonly associated with congenital heart malformations and intravenous (IV) drug abuse. We describe a case of a 40-year-old male who has established sickle cell disease and presented with pain crisis, febrile episodes, and oxygen desaturation on room air. The clinical presentation and echocardiographic findings of a pulmonic mass were consistent with the diagnosis of pulmonic valve endocarditis. Due to the small size of the pulmonic valve vegetation, the patient was treated with antibiotics and discharged home on antibiotics and home oxygen.

Self-Expanding Transcatheter Pulmonary Valve Implant in the Right Pulmonary Artery.

Newer self-expanding transcatheter pulmonary valves (TPVs) are approved for the treatment of severe pulmonary regurgitation in patients with large right ventricular outflow tracts. We present a patient with Tetralogy of Fallot whose right ventricular outflow tract was too large for self-expanding TPV, who was treated successfully with a self-expanding TPV in the right pulmonary artery. (Level of Difficulty: Advanced.).

Streptococcus oralis pulmonic valve endocarditis: a case report and review of the literature.

BACKGROUND: Several factors increase the risk of right-sided endocarditis. The tricuspid valve is usually involved in right-sided endocarditis cases. Infective endocarditis of the pulmonic valve is rare, and few cases of pulmonic valve endocarditis were reported previously. CASE PRESENTATION: Here we describe a case of a 81-year-old Middle Eastern male patient, admitted to our hospital three times in a period of 2 months for fever and cough. He had Streptococcus oralis bacteremia with vegetation that was on the pulmonic valve. We diagnosed him with pulmonic valve endocarditis, and he was treated successfully with intravenous antibiotics. CONCLUSION: It is important to keep high suspicion for isolated pulmonic valve endocarditis in patients with respiratory symptoms. Adequate dental care is important in patients with risk factors for infective endocarditis.

Left Pulmonary Artery Aneurysm: A Post-stenotic Pulmonary Aneurysm Related to Pulmonary Valve Stenosis.

Aneurysms of the pulmonary artery are uncommon vascular pathologies that are associated with congenital structural cardiac anomalies, pulmonary hypertension, vasculitis, neoplasm, iatrogenic, and infection. PAAs are commonly asymptomatic and accidentally diagnosed, however, if symptomatic, clinical features are generally non-specific and depend on the etiology of PAA. CT pulmonary angiography remains the gold standard imaging modality and other diagnostic imaging tests include transthoracic echocardiography and right heart catheterization. Definitive treatment of PAA is surgery, however, conservative management with close monitoring should be practiced in patients with poor surgical candidates or surgery is unlikely to improve survival. Here, we report a case of pulmonary artery aneurysm secondary to congenital pulmonary valve stenosis as well as a brief review of the literature regarding pulmonary artery aneurysms.

Asymptomatic Pulmonic Valve Mass: A Diagnostic and Therapeutic Dilemma.

Cardiac masses are not common but remain important in cardiology practice as they can cause havoc to a patient's life through obstructive and arrhythmogenic symptoms. These lesions mostly include vegetation, thrombi, and tumors. Myxomas are the most common primary cardiac tumor, primarily arising from the left heart chambers. It is exceedingly rare for a myxoma to emerge from the right-sided cardiac valves. The standard treatment is surgical resection, regardless of size, which is not always possible. We report a unique case of a male with multiple co-morbidities who presented with an incidental finding of a pulmonary valve mass suspicious of being a myxoma. The myxomatous mass was asymptomatic with no right ventricular outflow tract obstruction. Echocardiogram can help identify and characterize these lesions, but this may not be easy, especially in the case of atypical location or morphology of the mass. Similarly, in some cases, the patient may not be able to undergo surgical excision. In such cases, there is no consensus or guidelines to help clinicians best manage the patients medically, creating a diagnostic and therapeutic dilemma.