Click, Roger L.

The pulmonary valve is the least affected site for valvular papillary fibroelastoma. With increasing use of routine echocardiography and other modalities of imaging, pulmonary valve papillary fibroelastomas (PVPFE) are being recognized more frequently. PVPFE is more often an incidental diagnosis and symptomatic patients usually present with shortness of breath. Embolic phenomena and right ventricular outflow tract obstruction are the most serious complications of PVPFE. Since PVPFE is rare, the purpose of this systematic review is to address demographic characteristics, the clinical presentation, management, and outcome of this benign tumor of the pulmonary valve.

Mini‐AbstractWe present a case of a 25‐year‐old man with aortic regurgitation secondary to infective endocarditis. A preoperative transesophageal echocardiography demonstrated an abnormal aortic valve with possible vegetation or torn leaflet with severe aortic regurgitation, markedly dilated left coronary arteries, and a fistulous communication between the circumflex artery and the coronary sinus. The aortic valve was repaired and the coronary sinus arteriovenous fistula was ligated. At 1‐year follow‐up, there was no evidence of recurrent arteriovenous fistula or aortic regurgitation.

Mini‐AbstractWe present a case of a 76‐year‐old woman with new‐onset atrial flutter who underwent transesophageal echocardiography, which demonstrated a large left atrial mass consistent with myxoma and a “shimmering” mobile mass on the aortic side of the right coronary cusp, with fronds consistent with a papillary fibroelastoma. Such concurrent primary cardiac tumors of different histology are a rare occurence.

BACKGROUND Transient bacteremia may lead to endocarditis in patients with significant valvular lesions. METHODS AND RESULTS Because transesophageal echocardiography selects a patient population with a high prevalence of valvular lesions, we prospectively evaluated the risk of transient bacteremia associated with transesophageal echocardiography in 49 patients. Blood cultures were obtained immediately before transesophageal echocardiography and at 5, 10, and 20 minutes after the start of the procedure. For each culture, 30 ml venous blood was obtained and 10 ml was inoculated into each of an Isolator tube, Septi-chek bottle, and a nonvented Trypticase soy broth bottle. Broth cultures were incubated for 14 days. Blood from the Isolator tube was plated onto appropriate media for recovery of bacteria and fungi. Two patients were excluded from analysis because the final two sets of blood cultures could not be obtained. Among the remaining 47 study patients, two preprocedure control blood cultures were positive, and two of 141 subsequent cultures were positive. All isolates were considered contaminants. Thus, we found no significant bacteremia due to pathogenic oral flora during transesophageal echocardiography (0%; 95% CI, 0.0-7.5%). CONCLUSIONS Although recommendations for antimicrobial prophylaxis for transesophageal echocardiography should be individualized for each patient, many patients may not require antimicrobial prophylaxis.