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[Right-sided infective endocarditis with ventricular septal defect]
N Sasahashi1, F Ando, F Okamoto
1Department of Cardiovascular Surgery, Hyogo Kenritsu Amagasaki Hospital.
Insights
Surgical treatment for infective endocarditis with ventricular septal defect (VSD) involving Peptostreptococcus infection was successful in two patients. Early surgical intervention with vegetation excision and defect repair led to uneventful recovery.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Treatment
Background:
- Infective endocarditis (IE) with ventricular septal defect (VSD) requires timely management.
- Peptostreptococcus is a causative agent in some IE cases.
- Surgical intervention is often necessary for complex VSD and IE.
Observation:
- Two patients with right-sided IE and VSD caused by Peptostreptococcus presented for surgical treatment.
- Echocardiography identified vegetations in both patients: one on the chordae tendineae and the other on the tricuspid leaflet.
- Both patients underwent surgery after antibiotic therapy during a non-active phase of infection.
Findings:
- Case 1: A 7-year-old girl underwent direct VSD closure and vegetation excision.
- Case 2: A 22-year-old female had partial leaflet excision, autopericardial patch plasty for the tricuspid valve, and direct VSD closure.
- Both patients received 6 weeks of postoperative intravenous antibiotics and experienced uneventful clinical courses.
Implications:
- Local vegetation excision and autopericardial patch plasty are effective for VSD with localized vegetations and minor valvular regurgitation.
- Aggressive surgical management can lead to successful outcomes in complex IE and VSD cases.
- This approach highlights the importance of tailored surgical strategies based on vegetation characteristics and valvular involvement.
Abstract:
Two patients underwent surgical treatment for right-sided infective endocarditis with ventricular septal defect. In both cases, blood cultures showed Peptostreptococcus, and the operation was performed at non-active phase after antibiotics therapy. The case 1 was a 7-year-old girl who was observed a vegetation on the chorda of the anterior paillary muscle by echocardiography. The defect was directly closed and the vegetation was excised. The case 2 was 22-year-old female who had been diagnosed of VSD in her infancy. A high fever continued and echocardiography revealed a vegetation attached to the septal tricuspid leaflet. Partial excision of the leaflet and autopericard patch plasty was performed, and the VSD was directly closed. Postoperatively intravenous antibiotic therapy was given for periods of 6 weeks, and clinical course were uneventful in both cases. Local excision of vegetation and leaflet repair by autopericard patch plasty should be performed in cases with localized vegetation and minor valvular regurgitation.