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Infective endocarditis of a patent arterial duct in an adult, with vegetations extending to the aortic and pulmonary valves

Published online by Cambridge University Press:  01 October 2007

Suneil K Aggarwal and
Ramachandra Barik
Suneil K Aggarwal*
Affiliation:
Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, AP, India
Ramachandra Barik
Affiliation:
Department of Cardiology, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, AP, India
*
Correspondence to: Suneil K Aggarwal, Sri Sathya Sai Institute of Higher Medical Sciences, Prashantigram, AP – 515134, India. Tel: +91 9440 699299; Fax: +91 8555 287181; E-mail: suneilaggarwal@doctors.net.uk
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Abstract

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Keywords

Valvar infectionAdult congenital heart disease

Information

Type
Images in Congenital Heart Disease
Information
Cardiology in the Young , Volume 17 , Issue 5 , October 2007, pp. 565 - 566
Copyright
Copyright © Cambridge University Press 2007

A 25-year-old lady, from a remote Indian village, presented to our hospital with a 7-month history of intermittent fevers, loss of weight, and shortness of breath on exertion. She had been empirically treated for tuberculosis for 3 months at her local primary health centre, without relief of her symptoms. On examination, she was febrile and cachectic, with marked conjunctival pallor. There was a continuous murmur, with a thrill over the pulmonary area. There were no other stigmas of infective endocarditis. A chest X-ray was unremarkable.

A parasternal short axis view of her echocardiogram at the great arterial level (Fig. 1) showed extensive vegetations affecting all the leaflets of her aortic and pulmonary valves, as well as vegetations attached to the lateral wall of the pulmonary trunk (PULM = pulmonary, AOV VEG = aortic valve vegetations, PT = pulmonary trunk). A persistently patent arterial duct (PAD) was then discovered by colour Doppler. (Fig. 2 – RV = right ventricle; AO = ascending aorta; DESC AO = descending aorta) The tricuspid and mitral valves were unaffected. The patient declined treatment.

Figure 1

Parasternal short axis echocardiogram at the great arterial level showing vegetations on the pulmonary valve, aortic valve and along the wall of the main pulmonary artery.

Figure 2

Colour Doppler confirming presence of a patent arterial duct.

Prior to the advent of cardiothoracic surgery, infective endocarditis was the most common cause of death in adults with persistent patency of the arterial duct.Reference Ozkokeli, Mehmet, Uslu and Akcar1 Our case is a reminder of these times. To the best of our knowledge, only 3 cases of infective endocarditis with all the lesions described above have previously been reported, including one in which the patent arterial duct was diagnosed intraoperatively.Reference Ozkokeli, Mehmet, Uslu and Akcar1 Our echocardiograms uniquely demonstrate all the major vegetations in a single frame.

Acknowledgements

No funding has been acquired by either author.

References

1.Ozkokeli, M, Mehmet, A, Uslu, N, Akcar, M. Pulmonary and aortic valve endocarditis in an adult patient with silent patent ductus arteriosus. Jpn Heart J 2004; 45: 1057–1061.CrossRefGoogle Scholar
Figure 0

Figure 1Parasternal short axis echocardiogram at the great arterial level showing vegetations on the pulmonary valve, aortic valve and along the wall of the main pulmonary artery.

Figure 1

Figure 2Colour Doppler confirming presence of a patent arterial duct.