Double‐chambered right ventricle with pulmonary valve endocarditis

Abstract

Hospital, Sion, Bombay, India Summary: A rare case of isolated pulmonary valve endocarditis associated with a double-chambered right ventricle in a nonaddict, was diagnosed on two-dimensional echocardiography and cardiac catheterization and angiography. The patient was successfully operated and the above findings confirmed on the operation table.Key words: double-chambered right ventricle, isolated pulmonic valve endocarditis A 12-year-old boy presented to us with history of high grade fever and easy fatiguability of 15 days duration. There was no history of narcotic habits or intravenous injections given prior to the onset of these symptoms. There was no other positive history. On general examination the patient was toxic with evidence of severe congestive cardiac failure. Cardiovascular examination revealed findings of severe pulmonic stenosis with mild pulmonary regurgitation. Electrocardiogram showed sinus rhythm, right axis deviation, and right ventricular hypertrophy with strain. Chest roentgenogram showed minimal cardiomegaly with oligemic lung fields. The main pulmonary artery was not dilated. Laboratory examination showed anemia and leukocytosis with raised erythrocyte sedimentation rate. Repeated blood cultures were negative. Mmode echocardiogram revealed normal mitral, tricuspid, and aortic valves. Pulmonic valve showed thick multilayered dense echoes with systolic flutter. Twodimensional echocardiogram in parastemal short-axis view showed a dense globular mass on the posterior pulmonic leaflet which moved into the main pulmonary artery during systole and right ventricular outflow tract during diastole suggestive of flail pulmonary valve (Figs. I and 2). The right ventricle was concentrically thickened and a thick muscular band was seen in the right ventricular (RV) cavity. Cardiac catheterization showed RV pressures of 110/6 mmHg and systolic gradient of 90 mmHg across the RV body and RV outflow tract. Main pulmonary artery pressure was 20/12 mmHg. Right ventricular angiogram in frontal view showed a hypertrophied muscle band which divided the RV cavity in two, highly suggestive of doublechambered right ventricle (Fig. 3). There were no other associated defects. The patient was subsequently taken up for surgery after control of failure and treatment of infective endocarditis. On the operating table, the right ventricular cavity showed a thick hypertrophied muscle band dividing the right ventricular cavity into two chambers (proximal high and distal low pressure chambers) as seen on angiography. The posterior pulmonic valve was thickened, calcified, and was fenestrated in the center, suggesting healed infective endocarditis. AU other valves were normal. The muscle band was excised and pulmonic

Double‐Chambered Right Ventricle Associated with Mural and Pulmonic Valve Endocarditis: Description of a Clinical Case and Review of the Literature

“…The review of the literature in English reveals 2 cases of DCRV and valvar endocarditis 8,9 . In our report, two‐dimensional echocardiography clearly showed the congenital anatomic characteristics as well as the vegetations.…”

Bacterial endocarditis presenting in an adult patient with undiagnosed double‐chambered right ventricle

“…Few other case reports have described infectious bacterial endocarditis occurring with DCRV . Infective endocarditis is a known complication of CHD and is becoming more prevalent in patients who survive into adulthood .…”