{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,2]],"date-time":"2025-09-02T01:40:02Z","timestamp":1756777202657,"version":"3.44.0"},"reference-count":25,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T00:00:00Z","timestamp":1752105600000},"content-version":"unspecified","delay-in-days":9,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951125100875_as1\"><jats:title>Aim:<\/jats:title><jats:p>To examine the added value of an elevated calculated peak right ventricular outflow tract pressure gradient as a surrogate for infective endocarditis diagnosis.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100875_as2\"><jats:title>Methods:<\/jats:title><jats:p>A cohort study included patients admitted between 2003 and 2020 at a tertiary children\u2019s medical centre. Patients with surgically inserted exogenous right ventricular outflow tract conduits and infective endocarditis were included. Infective endocarditis was diagnosed using the revised Duke criteria (2023). Controls had right ventricular outflow tract conduits and febrile illness from other causes. Clinical, laboratory, and echocardiographic findings, including calculated peak right ventricular outflow tract pressure gradient, were collected.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100875_as3\"><jats:title>Results:<\/jats:title><jats:p>Among 26 febrile episodes (11 with infective endocarditis, 15 controls), the infective endocarditis group had a higher peak right ventricular outflow tract pressure gradient during acute illness (70 vs. 23 mmHg, <jats:italic>p<\/jats:italic> &lt; 0.05). On admission, 18% of infective endocarditis patients had a definite diagnosis by Duke\u2019s criteria, 45% had a probable diagnosis, and 36% lacked confirmation. Including peak right ventricular outflow tract gradient as a major criterion would yield a 90% diagnosis rate upon admission (45% definite, 45% possible).<\/jats:p><\/jats:sec><jats:sec id=\"S1047951125100875_as4\"><jats:title>Conclusions:<\/jats:title><jats:p>Increased right ventricular outflow tract pressure gradient in febrile patients with exogenous conduit in the right ventricular outflow tract is a potential marker for infective endocarditis. Including this gradient as a major Duke criterion enables earlier and more definitive diagnosis in debatable cases.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951125100875","type":"journal-article","created":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T13:32:07Z","timestamp":1752154327000},"page":"1421-1426","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Elevated pressure gradient in paediatric infective endocarditis: a possible new major Duke criteria"],"prefix":"10.1017","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3851-7334","authenticated-orcid":false,"given":"Michal","family":"Gafner","sequence":"first","affiliation":[{"name":"Schneider Children Medical Center"},{"name":"Tel Aviv University"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gal","family":"Sharvit","sequence":"additional","affiliation":[{"name":"Tel Aviv 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