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A case of intra-cardiac right-sided mural infective endocarditis associated with ventricular septal defect despite

Tina Lin1, Maria Santos, Craig Aboltins

  • 1Department of Cardiology, Northern Health, 185 Cooper Street, Epping, Victoria 3076, Australia. tina9989@gmail.com

Heart, Lung & Circulation
|June 15, 2010
PubMed

Insights

Bacterial endocarditis can occur in congenital heart disease. This case shows a rare right-sided infection linked to a ventricular septal defect after dental work, emphasizing potential bacteraemia risks.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Medical Microbiology

Background:

  • Bacterial endocarditis commonly affects cardiac valves in congenital heart disease.
  • Right-sided endocarditis is less frequent than left-sided, particularly in mural forms.
  • Ventricular septal defects (VSDs) are a known risk factor for infective endocarditis.

Observation:

  • A unique case of isolated intracardiac right-sided mural infective endocarditis associated with a VSD is presented.
  • The patient had undergone recent dental procedures despite antibiotic prophylaxis.
  • Clinical presentation included respiratory symptoms and sepsis, with negative blood cultures during hospitalization.

Findings:

  • Echocardiography and transesophageal echocardiography confirmed the presence of the endocardial lesion.
  • The infection was managed conservatively, highlighting a non-surgical initial approach.
  • The patient was referred for VSD closure post-conservative management.

Implications:

  • This case underscores the risk of bacteraemia from dental instrumentation, even with prophylaxis, in patients with specific cardiac defects.
  • It differentiates between risks associated with routine oral hygiene and invasive dental procedures.
  • Highlights the importance of considering atypical presentations and diagnostic challenges in infective endocarditis, especially with negative cultures.

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