Echocardiography for the diagnosis of infective endocarditis in heart transplant recipients

    Authors

    Keywords

    heart transplantation, infective endocarditis, transthoracic echocardiography, transesophageal echocardiography, immunosuppression

    DOI

    https://doi.org/10.15836/ccar2019.72

    Full Text

    Introduction : Post heart transplantation (HTx) infective endocarditis (IE) is unique among endocarditis after solid organ transplantation because it is the transplanted organ that becomes infected. Since 2016 two HTx patients have been successfully treated in University Hospital Dubrava for cardiac allograft infective endocarditis. Case report: The first one, a 77-year-old male patient, who in 2001 underwent orthotopic HTx due to ischemic cardiomyopathy, and who since 2010 was on hemodialysis due to chronic terminal kidney failure, was admitted in June 2016 due to mitral valve endocarditis ( Figure 1 ). The other one was a 29-year-old male patient who in January 2016 had undergone orthotopic heart transplantation due to dilated cardiomyopathy and was diagnosed in June 2017 with tricuspid valve endocarditis ( Figure 2 ). Both patients had atypical presentation, and in both patients transthoracic and transesophageal echocardiography were immediately performed revealing valve vegetations and proving crucial for establishing diagnosis. Empirical antibiotic treatment was initiated at once, and the patients were referred to the endocarditis team. Transesophageal echocardiography showing a vegetation on the anterior mitral leaflet. Transthoracic ultrasonography showing a large vegetation on the septal leaflet of tricuspid valve. Conclusion : IE is a known, but rare and very often fatal complication of HTx. Frequent central venous catheter access and multiple endomyocardial biopsies appear to predispose to infection ( 1 ). The prognosis of post-HTx IE remains poor. Atypical presentation is common in these patients ( 2 ), and therefore a high index of suspicion and low threshold for investigation are appropriate in this group in order to avoid delays in diagnosis ( 3 ). There are no specific guidelines to diagnostic practice for this particular group, however, echocardiography is the mainstay and essential in diagnosis of endocarditis ( 4 ), and therefore has to be performed at the earliest possible time.

    Cardiologia Croatica
    Back to search

    Echocardiography for the diagnosis of infective endocarditis in heart transplant recipients

    Extended Abstract
    Issue3-4
    Published
    Pages72
    PDF via DOIhttps://doi.org/10.15836/ccar2019.72
    heart transplantation
    infective endocarditis
    transthoracic echocardiography
    transesophageal echocardiography
    immunosuppression

    Authors

    Mario Udovičić*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Sandra Jakšić JurinjakORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Mira StipčevićORCIDZadar General Hospital, Zadar, Croatia
    Boris StarčevićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Igor RudežORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Vanja Ivanović MihajlovićORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Hrvoje FalakORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Danijela GrizeljORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Full Text

    Introduction : Post heart transplantation (HTx) infective endocarditis (IE) is unique among endocarditis after solid organ transplantation because it is the transplanted organ that becomes infected. Since 2016 two HTx patients have been successfully treated in University Hospital Dubrava for cardiac allograft infective endocarditis. Case report: The first one, a 77-year-old male patient, who in 2001 underwent orthotopic HTx due to ischemic cardiomyopathy, and who since 2010 was on hemodialysis due to chronic terminal kidney failure, was admitted in June 2016 due to mitral valve endocarditis ( Figure 1 ). The other one was a 29-year-old male patient who in January 2016 had undergone orthotopic heart transplantation due to dilated cardiomyopathy and was diagnosed in June 2017 with tricuspid valve endocarditis ( Figure 2 ). Both patients had atypical presentation, and in both patients transthoracic and transesophageal echocardiography were immediately performed revealing valve vegetations and proving crucial for establishing diagnosis. Empirical antibiotic treatment was initiated at once, and the patients were referred to the endocarditis team. Transesophageal echocardiography showing a vegetation on the anterior mitral leaflet. Transthoracic ultrasonography showing a large vegetation on the septal leaflet of tricuspid valve. Conclusion : IE is a known, but rare and very often fatal complication of HTx. Frequent central venous catheter access and multiple endomyocardial biopsies appear to predispose to infection ( 1 ). The prognosis of post-HTx IE remains poor. Atypical presentation is common in these patients ( 2 ), and therefore a high index of suspicion and low threshold for investigation are appropriate in this group in order to avoid delays in diagnosis ( 3 ). There are no specific guidelines to diagnostic practice for this particular group, however, echocardiography is the mainstay and essential in diagnosis of endocarditis ( 4 ), and therefore has to be performed at the earliest possible time.