© 2004 by European Society of Cardiology
Copyright © 2004, The European Society of Cardiology
Aneurysm of the membranous septum with ventricular septal defect and infective endocarditis
Department of Cardiology, Ziekenhuis Walcheren, Koudekerkseweg 88, Postbus 3200, 4380 DD Vlissingen, The Netherlands
Received 26 September 2003; received in revised form 17 February 2004; accepted after revision 24 February 2004.
* Corresponding author. Tel.: +31-118-425-000; fax: +31-118-425-331. j.m.j.b.walpot{at}walcheren.ziekenhuis.nl
Keywords: Infective endocarditis; Transesophageal echocardiography; Ventricular septal defect; Aneurysm of the membranous septum; Aortic valve prolapse
A 36-year-old female, with a history of aneurysm of the membranous septum (AMS) and ventricular septum defect (VSD), was evaluated because of fever 3 weeks after dental extraction without endocarditis prophylaxis.
The inflammatory parameters were elevated. The blood cultures were positive for Streptococcus viridans. TEE showed AMS with a small vegetation, prolapse of the aortic valve with mild regurgitation and a left-to-right shunt (Fig. 1a). A systolic gradient of 70 mmHg was measured with CW-Doppler through the VSD (Fig. 1b and c). The peripheral blood pressure was 110/65 mmHg and the systolic right ventricular pressure was 40 mmHg.
|
Infective endocarditis (IE) was treated with intravenous penicillin and tobramycin. Four months later, a Qp/Qs shunt of 1.4 was calculated during invasive work-up. She was submitted for surgical closure of the VSD, to prevent recurrent endocarditis and progressive aortic regurgitation. The AMS was resected partially and VSD was closed subsequently.
In the studies on VSD, the reported figures of infective endocarditis vary widely, ranging from 0%1 to 11.2%2 to 13.7%.3
Although the AMS has often been considered as relatively benign, Yilmaz et al.3 noted 6 main complications in patients affected with AMS and VSD: aortic valve prolapse (47%), aortic regurgitation (29.4%), tricuspid insufficiency (17.6%), IE (13.7%), obstruction of the right ventricular outflow tract (4%) and rupture of the aneurysm (2%).
 |
References |
|---|
 Top References |
|---|
- Onat T., Ahunbay G., Batmaz G., Celebi A. The natural course of isolated ventricular septal defect during adolescence. Pediatr Cardiol (1998) 19(3):230–234.[CrossRef][Web of Science][Medline]
- Neumayer U., Stone S., Somerville J. Small ventricular septal defects in adults. Eur Heart J (1998) 19(10):1573–1582.
[Abstract/Free Full Text] - Yilmaz A.T., Ozal E., Arslan M., Tatar H., Ozturk O.Y. Aneurysm of the membranous septum in adult patients with perimembranous ventricular septal defect. Eur J Cardiothorac Surg (1997) 11(2):307–311.[Abstract]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||