Surgical Treatment of Native Isolated Pulmonary Valve Endocarditis: A Systematic Review of the Literature

Objective: Isolated pulmonary valve endocarditis (IPVE) is a rare clinical entity among right-sided endocarditis. While antibiotic treatment is recommended as a first line strategy, indication, timing and the technique for the surgical approach is less clear. We took a case of IPVE at our department as an incentive to perform a systematic review on the indication, technique and outcome of surgical treatment for IPVE.

Methods: A systematic search for IPVE was performed on PubMed and Google Scholar using the terms “pulmonary valve endocarditis,” “pulmonic valve endocarditis” and “right-sided endocarditis” for the time between 2009 and 2017. Only English papers reporting on native IPVE in the adult was included. Patient characteristics, risk factors, etiopathogenesis and treatment modalities were extracted and analyzed.

Results: Systematic literature review identified 194 reports. After excluding duplicates and papers without full-text access 29 papers reporting 34 cases could be included. Most of the patients reported were male (66%), mean age was 49 ± 17 years with a range of 19–82. Predisposing factors were undetected congenital heart disease (VSD, ASD) (17%), intravenous drug abuse (17%), and central venous catheter (11%). Staphylococci were detected in 38% of the cases as the causative primary microorganisms. 62% of the patients suffered from septic emboli to the lung. Mean duration between onset of symptoms and diagnosis was 37 ± 31 days, the interval between diagnosis and surgery was 14 ± 12 days. Clinical deterioration and embolic complications were the main indications for surgery in 43% of the cases: 60% received surgical treatment and 40% remained on medical treatment. Valve replacement was performed using bio prosthesis (12), homografts (2) or mechanical prosthesis (1). The remaining patients received valve repair with autologous pericardium (5) or valvectomy (1). Mortality was significantly lower in the surgical group. Complication rate was significantly higher in the medical group, whereas no adverse events were reported after surgery early and in the mean follow-up time of 11 ± 19 months.

Conclusion: Isolated native pulmonary valve endocarditis is an uncommon, therefore late diagnosed and yet potentially fatal entity. Surgical treatment of native IPVE can be performed with good early and mid-term results. Therefore, it should be considered early in the treatment course, if medical treatment fails and the patient is in danger of complications.