Varicella zoster virus infection has been reported to be potentially complicated by IE185–189 in patients with or without preexisting heart condition In some of the reported cases, it may have fatal outcomes Not confirmed in children Contrary to previous impressions, children with congenital or acquired immunodeficiencies but without identifiable risk factors for IE do not appear to be at increased risk for IE, compared with the general population.3 Furthermore, factors often associated with IE in adults, such as intravenous drug abuse and degenerative heart disease, are not common predisposing factors in younger children.21,27 Hemodialysis is a leading risk factor, especially for S aureus IE in adults,190–193 but it seems this is not the case in children (unpublished): this might be related to the still relatively mild chronic renal failure–related ectopic valvar calcification in children Specific Previous Procedure and Device-Related Infective Endocarditis In 25% to 37% of cases, IE may develop in patients with CHD after previous cardiac operations.130,154,194 IE on Surgically Implanted RV-PA Conduits and Transcatheter Pulmonary Implanted Valves There has been a substantial increase of the number of surgical RV-PA conduits and transcatheter intrastent valve implantation It has become clear that the bovine jugular vein (BJV) RV-PA conduits (Contegra, VenPro Corporation) and intrastent valves (Melody, Medtronic) have slightly higher frequency of IE as compared with homografts and porcine heterografts Although there is no complete explanation, there has been a recent study showing increased bacterial adhesion for S aureus on BJV valves as compared with bovine pericardial valves.195–208 The comparison between the reported incidence of IE on transcatheter implanted Melody valve and different types of surgically implanted RV-PA conduits is presented in a comprehensive list of studies on Table 56.11 Table 56.11 Infective Endocarditis Incidence on Transcatheter and Surgically Implanted Pulmonary Valves Reference IE Pts/Total Incidence IE (%) Follow-Up Median (Min–Max) PULMONARY TRANSCATHETER IMPLANTED BJV MELODY VALVE Lurz et al, 2008196 5/155 3.2 0.4 (0.2–1.9) Cheung et al, 2013197 6/42 14.3 2.3 (0.2–5.5) 198 Buber et al, 2013 14/147 9.5 1.6 (0.1–5.3) McElhinney et al, 2013199 16/311 5.1 2.5 (5.1 max) 200 Butera et al, 2013 2/63 3.2 2.5 (1.0–4.0) Fraisse et al, 2014201 1/64 1.6 4.6 (0.2–5.2) Malekzadeh-Milani et al, 2014202 5/86 5.8 1.97 (0.2–2.4) 203 Cheatham et al, 2015 14/171 8.2 4.5 (0.4–7.0) VanDijck et al, 2015204 8/107 7.5 2.0 (0.3–7.8) RV-PA SURGICALLY IMPLANTED BJV CONTEGRA CONDUITS VanDijck et al 2015204 11/53 20.4 8.8 (0.7–13.5) Albanesi et al, 2014205 12/106 11.3 7.6 (1.7–12.7) Ugaki et al, 2015206 23/244 9.4 3.2 (0.1– 11.7) 207 Mery et al, 2016 14/245 5.7 7.0 (0.02–20) Sandica et al, 2016208 24/444 5.4 4.3 ± 3.8 RV-PA SURGICALLY IMPLANTED CRYOPRESERVED HOMOGRAFTS VanDijck et al 2015204 14/517 2.4 6.5 (0.1–23.7) Ugaki et al, 2015206 1/135 0.7 4.3 (0.1–11.6) Mery et al, 2016207 4/410 0.9 7.0 (0.02–20) 208 Sandica et al, 2016 2/267 0.7 6.6 ± 5.4 RV-PA SURGICALLY IMPLANTED DECELLULARIZED PULMONARY HOMOGRAFTS Sarikouch et al, 2016209 0/131 4.59 ± 2.76 BJV, Bovine jugular vein; IE, infective endocarditis; RV-PA, right ventricle-to-pulmonary artery Peculiarities of Infective Endocarditis on Transcatheter Implanted Pulmonary Valves ■ The time from implantation to IE varies: it is possible to develop IE early (1 month) or at any point later ■ The causal agent varies: it seems S aureus is rarer, and oral streptococci, HACEK organisms, and Corynebacterium spp are disproportionately represented204; there are several reports of Bartonella spp IE.210–212 ■ The diagnosis cannot rely on echocardiography alone because the positive sign of vegetations is relatively low (up to 50%)204; intracardiac echo is reported as a possibility,33 but it is impractical and CT is preferred as additional imaging ■ Acute obstruction of the valve is reported as an important complication that may require urgent surgery.204, 213,214 ■ Conservative-only management might be effective in up to 64% However, despite the belief of a relatively low rate of reinfection,33 a significant proportion will eventually require surgery ■ IE-related mortality risk varies between reports: a recent meta-analysis calculated it as 9.1%,215 which is similar to the pediatric IE as a whole Infective Endocarditis of Atrial Septal Defect Closure Devices IE may exceptionally rarely occur after ASD Amplatzer occluder device (ASO; St Jude Medical [SJM]) implantation, related to incomplete neoendothelialization of the device beyond the expected 6 months after the procedure A review published in 2016216 summarized a total of six IE cases described in the literature,217–222 at 11 months to 4 years after the procedure, mostly caused by S aureus; there are an additional two cases published.223,224 IE is very rare considering this small number of cases for the more than 300,000 devices implanted worldwide The possibility of incomplete neoendothelialization of the device beyond 6 months after the procedure as a predisposing factor of IE may be of importance; however, there is currently no method available to visualize this finding Implantable Cardiac Electronic Device–Related Infective ... ■ IE-related mortality risk varies between reports: a recent meta-analysis calculated it as 9.1%,215 which is similar to the pediatric IE as a whole Infective Endocarditis of Atrial Septal Defect Closure Devices IE may exceptionally rarely occur after ASD Amplatzer occluder device (ASO;