Acquired Ventricular Septal Defect Secondary to Aortic Valve Endocarditis

Introduction : Infective endocarditis remains a deadly disease with an in-hospital mortality rate of around 20%. While ventricular septal defects (VSDs) have been linked to an increased risk of infective endocarditis, cases of acquired VSDs resulting from infective endocarditis are not well-documented in the literature. Our report highlights a rare case of acquired VSD that resulted directly from aortic valve endocarditis. Case Presentation : A 57-year-old male presented to an outside hospital with chest pain, shortness of breath, and low-grade fevers for the past seven days. Additionally, poor dentition was noted. Blood cultures detected gram-positive staphylococci and streptococcus anginosus. Due to concern for endocarditis, an order was placed for both a transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE). Results showed aortic regurgitation, stenosis, and a mobile growth. The patient was managed with IV antibiotics until transferred. Upon arrival at our facility, TEE revealed a VSD that demonstrated left-to-right flow into the right ventricle. Due to the risk of cardiac decompensation and septic embolization, immediate surgical intervention was necessary. The aorta was opened, and the diseased aortic valve was excised. The necrotic septum was debrided and an acquired VSD the size of a quarter was identified. A pericardial patch was used to repair the VSD. Following debridement a mechanical aortic valve was placed. The patient was taken to ICU in a stable condition. However, several days following the procedure, the patient developed ongoing arrhythmia, and a permanent pacemaker was placed. Conclusions : It has been well-documented in literature that congenital VSDs are associated with an increased incidence of endocarditis. However, only a few cases have been documented where a VSD results directly from aortic valve endocarditis. This is the first recorded case of an adult in the U.S. with native aortic valve gram-positive staphylococci and streptococcus anginosus endocarditis resulting in a large acquired VSD. The condition was successfully diagnosed and treated with surgery. Successful treatment of post-operative arrhythmia with permanent pacemaker placement was achieved- a first for acquired VSD caused by infectious endocarditis.