Pulmonary aortic endocarditis in patient with patent ductus arteriosus

Abstract

Introduction: Right-sided heart endocarditis is uncommon, comprising only 5-10% of all infective endocarditis cases. The infective process may be isolated to pulmonary valve or concomitantly involve other valves. Prompt diagnosis by transthoracic echocardiography, aggressive antibiotics from the beginning, and surgical removal of the vegetation for infective endocarditis help prevent the risk of multiorgan failure and fatal pulmonary embolism.

Case summary: A 38-year-old female, the medical history was normal, gave birth naturally at a district hospital 3 months ago. She admitted to the hospital because of fever and continuous shortness of breath 1 month before admission. Echocardiography detected: vegetations (10x23mm) on left pulmonary aortic and patent ductus arteriosus. A CT scan showed a mixed-echo mass in the left pulmonary artery. The patient had surgery to remove the vegetation and close the patent ductus arteriosus. The patient was stable after surgery and discharged 2 weeks after surgery.

Conclusion:  Pulmonary aortic vegetations and patent ductus arteriosus are rare lesions and high risk of death. The diagnosis should be considered in any febrile, septic patient with congenital heart disease. Surgery removal of vegetations and aggressive antibiotic treatment should be performed together to improve the outcome.