Echocardiographic demonstration of pulmonary valve endocarditis associated with congenital ventricular septal defect.

Abstract

SUMMARY A 38 year old woman previously known to have a heart murmur presented with malaise and bloodstained sputum. Echocardiographic examination showed a subpulmonary ventricular septal defect and probable vegetations on the pulmonary valve, and blood cultures grew Escherichia coli. She made a full recovery after 6 weeks' antibiotic treatnent.The pulmonary valve is rarely affected by subacute bacterial endocarditis and it is the most difficult of the four cardiac valves to visualise by echocardiography. Consequently there are few reports of the echocardiographic demonstration of pulmonary valve vegetations. We present an unusual case in which pulmonary valve vegetations were found in association with a jet lesion from a subpulmonary ventricular septal defect. Case reportA 38 year old Greek woman with a three month history of general malaise and myalgia and a cough productive of bloodstained sputum who had been told she had a congenital heart lesion travelled to the United Kingdom to seek medical advice.On examination she was generally well with no stigmata of subacute bacterial endocarditis. Her blood pressure was 120/90 mm Hg with a heart rate of 72 beats/min. There was a loud pansystolic murmur with an associated thrill at the left stemal edge and a soft early diastolic murmur over the pulmonary area that was best heard in inspiration. Her chest x ray showed an enlarged cardiac shadow and pulmonary plethora, but no evidence of pulmonary emboli. The electrocardiogram was within normal limits. A cross sectional echocardiogram showed a ventricular septal defect below the pulmonary valve (Fig. 1), and the presence of a high-velocity jet across this lesion was confirmed with pulsed

Escherichia Coli Endocarditis of the Aortic Valve with Formation of a Paravalvular Abscess Cavity

“…The aggressiveness of the bacteria is obviously a reason for poor prognosis in E. coli endocarditis 2–5 . Another, perhaps even more important factor, is the time delay from the first medical contact to the establishment of the diagnosis.…”

“…The lack of echocardiography as a diagnostic tool in the first part of that period may have influenced the prognosis. Despite echocardiographic surveillance, the disease may have dramatic consequences caused by the occurrence of rapid destruction of cardiac tissue 2–5 . Endocarditis with formation of abscess cavities 6 and absence of valvular destruction might progress without significant hemodynamic perturbations and with minimal symptoms.…”

“…Escherichia coli ( E. coli ) endocarditis is a relatively rare condition, 1 but some cases, involving both left‐ and right‐sided valves have been reported 2–5 . No cases have been reported in our hospital during the last 12 years.…”