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Closure of a Patent Foramen Ovale PFO: An Intervention Sequence
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Case report: septic embolism through patent foramen ovale in mitral valve endocarditis

Mohammad Abumehdi1, Maraisa Fachini Spada1, Thomas Semple1

  • 1Paediatric Cardiology Services, Royal Brompton Hospital and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.

European Heart Journal. Case Reports
|October 9, 2023
PubMed
Abstract

Insights

Septic pulmonary emboli, typically from the right heart, were observed originating from the left heart in a child with infective endocarditis. This rare case highlights emboli migration through a patent foramen ovale (PFO).

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pediatrics

Background:

  • Infective endocarditis commonly leads to septic emboli, usually downstream from the vegetation.
  • Left-sided heart embolization to the pulmonary circulation is exceptionally rare, particularly without congenital heart disease.

Observation:

  • A 4-year-old boy with infective endocarditis presented with a new murmur and mitral valve vegetation.
  • Echocardiography revealed severe mitral regurgitation and a patent foramen ovale (PFO), with no congenital heart defects.
  • The patient developed septic pulmonary emboli despite the absence of right-sided vegetation.

Findings:

  • This case presents a rare instance of septic pulmonary emboli originating from left-sided infective endocarditis.
  • The likely mechanism involved emboli migration from the left atrium to the right atrium via a PFO.
  • Successful treatment included antibiotics, mitral valve surgery, and valvuloplasty.

Implications:

  • This case expands the understanding of paradoxical embolism in infective endocarditis.
  • It underscores the importance of considering left-to-right shunt pathways in cases of unexplained pulmonary emboli.
  • Early diagnosis and intervention are crucial for favorable outcomes in pediatric infective endocarditis with complex embolic events.
Keywords:
Infective endocarditisMitral regurgitationPatent foramen ovalePulmonary embolism

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