Pulmonary Valve Infective Endocarditis in an Adult Patient with Severe Congenital Pulmonary Stenosis and Ostium Secundum Atrial Septal Defect

[摘要] A hypertensive 76-year-old man with severe pulmonary valvestenosis (PVS) and recent initiation of haemodialysis was referredwith fever, chills, and asthenia. One month prior, he had beenadmitted with similar symptoms. Transthoracic echocardiography(TTE) had shown a PVS and no valve vegetations were observed. Following discharge, he was readmitted with fever and bloodcultures positive forStaphylococcus haemolyticus. A new TTErevealed two pulmonary valve vegetations and a previouslyundetected ostium secundum-type atrial septal defect (ASD),confirmed by transesophageal echocardiography. The clinical coursewas uneventful with intravenous antibiotic treatment and thepatient was safely discharged. This is a case of pulmonary valveinfective endocarditis (IE). The incidence of right-sided IE is onthe rise due to the increased number of patients using centralvenous lines, pacing, haemodialysis and other intravasculardevices. Pulmonary valve IE is extremely rare, especially instructurally normal hearts. The case reported here, presents acombination of predisposing factors, such as severe congenitalPVS, the presence of a central venous catheter, and haemodialysis. The fact that it was an older patient with severe congenital PVSand associated with a previously undiagnosed ASD, is also anunusual feature of this case, making it even more interesting.

[学科分类] 心脏病和心血管学