Right-sided infective endocarditis in association with a left-to-right shunt complicated by haemoptysis and acute renal
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2020) 20:494
Open Access
CASE REPORT
Right‑sided infective endocarditis in association with a left‑to‑right shunt complicated by haemoptysis and acute renal failure: a case report Rubi Stephani Hellwege* and Meinrad Gawaz
Abstract Background: Infective endocarditis has a relevant clinical impact due to its high morbidity and mortality rates. Rightsided endocarditis has lower complication rates than left-sided endocarditis. Common complications are multiple septic pulmonary embolisms, haemoptysis, and acute renal failure. Risk factors associated with right-sided infective endocarditis are commonly related to intravenous drug abuse, central venous catheters, or infections due to implantable cardiac devices. However, patients with congenital ventricular septal defects might be at high risk of endocarditis and haemodynamic complications. Case presentation: In the following, we present the case of a 23-year-old man without a previous intravenous drug history with tricuspid valve Staphylococcus aureus endocarditis complicated by acute renal failure and haemoptysis caused by multiple pulmonary emboli. In most cases, right-sided endocarditis is associated with several common risk factors, such as intravenous drug abuse, a central venous catheter, or infections due to implantable cardiac devices. In this case, we found a small perimembranous ventricular septal defect corresponding to a type 2 Gerbode defect. This finding raised the suspicion of a congenital ventricular septal defect complicated by a postendocarditis aneurysmal transformation. Conclusions: Management of the complications of right-sided infective endocarditis requires a multidisciplinary approach. Echocardiographic approaches should include screening for ventricular septal defects in patients without common risk factors for tricuspid valve endocarditis. Patients with undiagnosed congenital ventricular septal defects are at high risk of infective endocarditis. Therefore, endocarditis prophylaxis after dental procedures and/or softtissue infections is highly recommended. An acquired ventricular septal defect is a very rare complication of infective endocarditis. Surgical management of small ventricular septal defects without haemodynamic significance is still controversial. Keywords: Case report, Right-sided endocarditis, Ventricular septal defect, Gerbode defect, Tricuspid valve, Staphylococcus aureus, Glomerulonephritis, Haemoptysis, Septic pulmonary embolisms
*Correspondence: [email protected]‑tuebingen.de; [email protected] Department of Cardiology and Angiology, University Hospital, University of Tübingen, Tübingen, Germany
Background The diagnosis and management of patients with infective endocarditis (IE) require extensive clinical assessment, advanced cardiac imaging, and an interdisciplinary approach to decrease morbidity and mortality. Rightsided IE has a lower prevalence (10–15%) with lower
© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits us
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