[A successful repair of acquired left ventricular-right atrial communication due to infective endocarditis]

A 17-year-old boy, who had suffered from streptococcal infective endocarditis, was referred to our hospital because of the uncontrolled infection and severe right ventricular failure despite 2 months of vigorous antimicrobial therapy. Preoperative two-dimensional and Doppler echocardiography revealed a shunt from the left ventricule or aorta to the right atrium. Both aortic and tricuspid valves had vegetations and severe regurgitations. He underwent an operation because of the persistent infection and worsening heart failure. Intraoperatively, the aortic valve was found to be severely damaged and to have numerous vegetations on both surfaces. The tricuspid valve had multiple vegetations on the atrial surface only, and its annulus was markedly dilated. There was a perforation in the septal leaflet of the tricuspid valve, and an exploration of the focal site disclosed a perimembranous ventricular septal defect (VSD) communicating directly between the left ventricle and right atrium. Aortic and tricuspid valve replacements and patch closure of the VSD were done successfully and his postoperative course was uneventful except for the episode of ventricular tachycardia, torsade de pointes, on the fifth postoperative day.