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[Acquired ventricular septal defect during infective endocarditis]
F Tarasoutchi1, M Grinberg, J A Barreto Filho
1Instituto do Coração do Hospital das Clínicas-FMUSP, São Paulo.
Abstract:
We studied five patients with acquired ventricular septal defect during the course of an infective endocarditis. All patients were male and had a previous aortic valve disease associated with an aortic ring abscess. Clinical examination was useful for the diagnosis of 4 cases, emphasizing the following findings: systolic murmur and/or left paraesternal thrill and right-heart failure. Incidence of congestive heart failure was 60%, while 40% of all patients died during the in-hospital course. No specific etiologic agent was detected. Therefore, acquired ventricular septal defect should be suspected in patients with infective endocarditis of the aortic valve that evolve with a systolic murmur and/or paraesternal thrill and right-heart failure. Immediate surgical treatment is mandatory in these cases.
Insights
Acquired ventricular septal defect, a complication of infective endocarditis, presents with specific clinical signs. Early surgical intervention is crucial for patients with aortic valve endocarditis and these symptoms.
Area of Science:
- Cardiology
- Infectious Diseases
- Cardiac Surgery
Background:
- Infective endocarditis (IE) can lead to serious cardiac complications.
- Aortic valve disease and aortic ring abscesses are predisposing factors for IE complications.
- Acquired ventricular septal defect (VSD) is a rare but severe complication of IE.
Observation:
- Five male patients with acquired VSD secondary to infective endocarditis were studied.
- All patients had pre-existing aortic valve disease and aortic ring abscess.
- Clinical diagnosis was achieved in 4 cases, indicated by systolic murmur, left parasternal thrill, and right-heart failure.
Findings:
- Congestive heart failure occurred in 60% of patients.
- In-hospital mortality rate was 40%.
- No specific causative pathogen was identified.
Implications:
- Acquired VSD should be suspected in patients with aortic valve IE presenting with new systolic murmurs, parasternal thrill, or right-heart failure.
- Prompt surgical treatment is essential for managing acquired VSD in this context.
- This highlights the critical need for timely diagnosis and intervention in complex IE cases.