Pulmonary valve endocarditis in a patient with patent ductus arteriosus

Introduction: The majority of cases of right sided in-fective endocarditis involve the tricuspid valve. Isolated pulmonary valve (PV) endocarditis is rare. Congenital heart disease are risk factors.

Methods: We present the case of 36 years old male, wi-thout any known cardiovascular disease, who was ad-mitted with signs and symptoms of heart failure, cough with hemoptysis and fever. He was evaluated clinically, 12 lead ECG, pulmonary radiography, thoracic compu-ter tomography (CT) scan, transthoracic and transeso-phageal echocardiography, laboratory investigations.

Results: Clinical examination revealed: cardiomegaly, continuous murmur in second space left parasternal border, ratting rallies at the level of basal left thorax, hepatomegaly and splenomegaly; laboratory findings: leukocytosis, high plasmatic levels of C reactive prote-in, fibrinogen, erythrocyte sedimentation rate and d-dimers; blood cultures were negative. ECG aspect was of right bundle branch block. Transthoracic and tran-sesophageal echocardiogram found large vegetations located on pulmonary valve, pulmonary regurgitation and dilation of the pulmonary valve, patent ductus ar-teriosus (PDA) with bidirectional shunt and local com-plications: fistula between right ventricle outflow tract (RVOT) and aorta, pleural and pericardial effusion. Radiography and thoracic CT scan revealed pulmonary embolism aspect, pleural and pericardial effusion. The patient was treated with antibiotics and surgical option included debridement of the infected area, vegetation excision with valve replacement, relief of RVOT, fistu-la closure with pericardial patch and ligature of PDA. Evolution after surgical intervention was good.

Conclusions: This presentation reveals a favorable evo-lution of a patient with infective endocarditis located to pulmonary valve. In most of cases, right heart endocar-ditis presents with signs and symptoms of respiratory disease and fever; these are due to septic pulmonary embolization. So, isolated PV endocarditis still remains a challenging and needs carefully evaluation for a cor-rect diagnosis and risk factors identification.

ISSN
ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CNCSIS B+
CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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