European Journal of Echocardiography 2007 8(1):48-49; doi:10.1016/j.euje.2006.06.008
Copyright © 2007, The European Society of Cardiology
Atrial septal endocarditis
Andrew R.J. Mitchell*,
Paul Leeson,
Jonathan Timperley,
Saul G. Myerson,
Harald Becher and
Jonathan Goldman
Department of Echocardiography, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
Received 11 April 2006; received in revised form 5 June 2006; accepted after revision 15 June 2006.
* Corresponding author. Tel.: +44 1865 220981; fax: +44 1865 221432. mitcharj{at}doctors.org.uk
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Abstract
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Atrial septal endocarditis can occur as an isolated event or
in association with valvular endocarditis. It is also reported
following percutaneous device closure of atrial septal defects.
We present the echocardiography findings from a young man presenting
with endocarditis of an abnormal mitral valve in whom endocarditis
was demonstrated associated with an atrial septal defect.
Keywords: Endocarditis; Atrial septal defect; Echocardiography
A 24-year-old man presented with a short history of fever and swollen lower limbs. Physical examination revealed signs of significant mitral regurgitation and blood cultures grew Streptococcus viridans. Transoesophageal and transthoracic echocardiography demonstrated prolapse of the mid-portion (P2) of the posterior mitral valve leaflet with severe mitral regurgitation. There was a 9mm by 9mm vegetation attached to the abnormal leaflet (Fig. 1). Echocardiography also identified a 10mm secundum atrial septal defect (Fig. 2) with left to right shunting of the mitral regurgitation jet through the defect (Fig. 3). Along the inferior left atrial side of the septal defect were multiple small mobile masses in keeping with endocarditis of the atrial septum (Figs. 4 and 5). The patient was treated with a four-week course of antibiotics with rapid clinical improvement and resolution of the vegetations. One month later the patient underwent mitral valve repair and closure of the atrial septal defect without complication.
Atrial septal endocarditis is uncommon but has been reported
in patients in isolation and in association with endocarditis
of other heart valves.
1–4 Endocarditis of the atrial septum
is also recognised following percutaneous closure of atrial
septal defects.
5,6 In patients presenting with valvular endocarditis
it is important to consider transoesophageal echocardiography
to closely examine all cardiac valves in addition to excluding
co-existent congenital abnormalities.
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Supplementary data
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Supplementary data associated with this article can be found
in the online version, at
10.1016/j.euje.2006.06.008
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References
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