Pulmonary valve endocarditis caused by right ventricular outflow obstruction in association with sinus of valsalva aneurysm: a case report

Nishida, Katsufumi; Fukuyama, Osamu; Nakamura, Dean S

doi:10.1186/1749-8090-3-46

Cited by 18 publications

(16 citation statements)

References 14 publications

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“…Although there have been case reports of pulmonary valve endocarditis previously, they usually presented as septic pulmonary embolism with mild pulmonary regurgitation, [5][6][7] and as to our knowledge, there has not been a report of a patient who presented with fulminant pulmonary valve endocarditis as in our patient.…”

Section: )5)mentioning

confidence: 59%

Pulmonary Valve Endocarditis with Septic Pulmonary Thromboembolism in a Patient with Ventricular Septal Defect

Park

Cho

Kim

et al. 2009

J Cardiovasc Ultrasound

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We describe a 42-year-old man who presented as life-threatening sepsis and septic shock with multiple septic pulmonary embolism and septic pneumonia due to pulmonary valve endocarditis. The patient had history of untreated ventricular septal defect (VSD) and complained of severe dyspnea and orthopnea. Transthoracic and transesophageal echocardiograms revealed severe pulmonary regurgitation with large, hypermobile vegetation on pulmonary valve and right ventricular outflow tract (RVOT), and a small subarterial type VSD. Emergency operation was done due to rapid deterioration of the patient, and after 6 weeks of antibiotics coverage, he was discharged. online © ML Comm L/min, at which oxygen saturation (SaO2) was 91%. The initial chest X-ray showed multifocal consolidation and grassground opacity (GGO) at both lung fields. Transthroacic echocardiogram revealed dilated right ventricle (RV) with hypertrophy and severe pulmonary regurgitation with large, hypermobile vegetation on pulmonary valve and right ventricular outflow tract (RVOT). The pulmonary valve was severely destructed, with almost invisible remnant functioning leaflet tissue, which accounted for the torrential pulmonary regurgitation (Fig. 1A). Other cardiac valves were clear, with normal morphology and function. Chest CT showed diffuse irregular thickening of pulmonary valve, multifocal pulmonary embolism and diffuse GGO with multifocal patchy and nodular consolidations at both lungs (Fig. 2). The clinical course of the patient progressed rapidly, with development of hypotension and rapid progression of hypoxia despite full oxygen and inotropics supplement. The patient monitor revealed SaO2 of 50% even at full oxygen support via facial mask and systolic blood pressure of 77 mmHg, and he was admitted to intensive care unit (ICU) after intubation. A portable transesophageal echocardiogram revealed a small ventricular septal defect with left to right shunt and multiple huge mobile echogenic mass at right ventricle side of VSD and RVOT (Fig. 1B). The patient was sent for emergency operation. A 0.8 cm-sized subarterial type VSD was repaired. Massive amount of vegetation and thrombus was found in RV and RVOT which extended to pulmonary valve and caused extensive valve destruction. The pulmonary valve was replaced with a mechanical valve. No bacteria was grown from the blood culture, but pathologic specimen of the tissue showed fibrinous exudates with colonies of numerous cocci and chronic active inflammation. A combination of ampicillin, nafcillin and gentamicin was continued, and at post-op day 5, the patient was transferred to sub-ICU. After 6 weeks of combination antibiotics therapy, the patient was discharged. A B D Di is sc cu us ss si io on nRight-sided endocarditis is relatively rare and mainly affects the tricuspid valve. Pulmonary valve endocarditis is even rarer than tricuspid valve endocarditis, and comprises less than 2% of hospital admissions for endocarditis. Different hemodynamic pressure gradients across the valves, different frequencies of ...

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Section: )5)mentioning

confidence: 59%

Pulmonary Valve Endocarditis with Septic Pulmonary Thromboembolism in a Patient with Ventricular Septal Defect

Park

Cho

Kim

et al. 2009

J Cardiovasc Ultrasound

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“…Nishida et al [2] reported a case of a pulmonary valve endocarditis caused by the RVOT obstruction in association with aneurysm of the sinus of Valsalva. Aneurysm of the right sinus of Valsalva can protrude into the RVOT and cause obstruction [2][3][4].…”

Section: Discussionmentioning

confidence: 98%

“…Aneurysm of the right sinus of Valsalva can protrude into the RVOT and cause obstruction [2][3][4]. The high-velocity jet created by the RVOT obstruction is usually responsible for the endothelial damage of the pulmonary valve and predisposes to infective endocarditis [2].…”

Section: Discussionmentioning

confidence: 99%

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Pulmonary valve endocarditis associated with a ruptured aneurysm of the right sinus of Valsalva

Wan

Wei

et al. 2010

Journal of Cardiology Cases

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Pulmonary valve endocarditis is an extremely rare complication of aneurysm of the sinus of Valsalva. We report the case of a 26-year-old male patient who presented with pulmonary valve endocarditis which was associated with a ruptured aneurysm of the right sinus of Valsalva with aorto-right ventricular outflow tract fistula and aortic valve endocarditis. He underwent aortic valve replacement with a 23 mm pericardial bioprosthesis, reconstruction of the right sinus of Valsalva using a pericardial patch, and debridement of pulmonary valve leaflet vegetations. The operation was a complete success. Intraoperative transesophageal echocardiography showed no residual shunt within the reconstructed right coronary sinus, normal function of aortic bioprosthesis, and mild mitral, tricuspid, and pulmonary regurgitation. Postoperative antibiotics were continued and the patient recovered uneventfully.

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“…Right-sided involvement in endocarditis is generally uncommon, making up approximately 5% of all cases found yearly. Many of the examples seen in patients with right-sided endocarditis are intravenous drug users, patients with congenital heart disease, pace makers, and central venous lines [5–7]. …”

Section: Rare Vegetationmentioning

confidence: 99%

Lemierre’s Syndrome: A Rare Case of Pulmonic Valve Vegetation

Kwan

Mastrine

Moskovits

2013

Case Reports in Infectious Diseases

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Lemierre's syndrome is an uncommon complication of pharyngitis commonly associated with an anaerobic gram negative bacterium, Fusobacterium necrophorum. The syndrome usually affects young healthy adults with the mean age of 20 and is characterized by recent pharyngitis followed by ipsilateral internal jugular vein thrombosis and septic thromboembolism. The treatment is at least 6 weeks of antibiotics; the role of anticoagulation is unclear. The following presentation is a case of Lemierre's syndrome in a 23-year-old healthy individual who is infected by a rare species: Fusobacterium nucleatum. The case is complicated by septic emboli to the lungs and impressive seeding vegetation to the right ventricular outflow tract (RVOT) at the pulmonic valve of the heart.

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Pulmonary valve endocarditis caused by right ventricular outflow obstruction in association with sinus of valsalva aneurysm: a case report

Cited by 18 publications

References 14 publications

Pulmonary Valve Endocarditis with Septic Pulmonary Thromboembolism in a Patient with Ventricular Septal Defect

Pulmonary Valve Endocarditis with Septic Pulmonary Thromboembolism in a Patient with Ventricular Septal Defect

Pulmonary valve endocarditis associated with a ruptured aneurysm of the right sinus of Valsalva

Lemierre’s Syndrome: A Rare Case of Pulmonic Valve Vegetation

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