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A Rare Case of Pulmonary Artery Dissection Associated With Infective Endocarditis
Xiaoqing Shi1, Xiaoqin Wang, Chuan Wang
1From the Department of Pediatrics (XS, XW, CW, KZ, YL, YH), West China Second University Hospital, Sichuan University; Key Laboratory of Ministry of Education for Women and Children's Diseases and Birth Defects (XS, XW, CW, KZ, YL, YH), West China Second University Hospital, Sichuan University; and The Changjiang Scholar Program and Innovative Research Team in University (KZ, YH), West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.
Insights
Pulmonary artery dissection (PAD) is a rare complication of infective endocarditis (IE). This case report details the successful surgical management of a pediatric patient with IE, a patent ductus arteriosus (PDA), and PAD, highlighting early intervention benefits.
Area of Science:
- Cardiology
- Thoracic Surgery
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious infection, typically affecting heart valves.
- Pulmonary artery dissection (PAD) is a rare, high-mortality condition rarely associated with IE.
- Patent ductus arteriosus (PDA) is a congenital heart defect that can complicate IE management.
Observation:
- A 10-year-old female with IE, PDA, and a pulmonary artery trunk vegetation presented with sudden chest pain and respiratory distress.
- Echocardiography confirmed vegetation detachment and subsequent pulmonary artery dissection.
- The dissection involved an aneurysm adjacent to the PDA.
Findings:
- The patient underwent successful surgical repair of the dissected pulmonary artery and closure of the PDA.
- Histopathology confirmed an aneurysm at the dissection site.
Implications:
- This case highlights the potential for PAD as a complication in IE patients with PDA and pulmonary artery vegetations.
- Early surgical intervention after infection control may be crucial for preventing severe outcomes in such cases.
- This report underscores the importance of considering surgical management for IE with complex associated anomalies.
Abstract:
Pulmonary artery dissection (PAD) is a rare condition with high mortality and has not been reported in patient with infective endocarditis (IE). Here, we report the first case of such patient who experienced PDA and survived after surgical intervention.A 10-year-old female child was diagnosed as IE with a patent ductus arteriosis (PDA) and a vegetation on the left side of pulmonary artery trunk (10 × 5 mm). Following 3-week antibacterial treatment, the body temperature of patient returned to normal, and the size of vegetation reduced (7 × 3 mm). However, the patient had a sudden attack of sustained and crushing right chest pain, orthopnea with increasing respiratory rate (> 60/min), and acute high fever. Echocardiography revealed the detachment of vegetation on the first day and dissection of pulmonary artery on the next day. The patient received immediate surgical intervention. It was found that aneurysm had a size of 28 × 20 mm and its orifice (the dissecting site) located on the opposite side of the PDA opening (right side of the pulmonary artery trunk). The dissected left wall of pulmonary artery trunk was reconstructed followed by the closure of PDA with suture. The patient recovered uneventfully.From this case, we learned that the surgical intervention should be considered at an early time for IE patients who have a vegetation in pulmonary artery and PDA. After the infection is under control, the earlier surgery may prevent severe complications.
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