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HERDIN Record #: NCR-PHC-17090411154143 Submitted: 04 September 2017 Modified: 04 September 2017

Infective Endocarditis in a patient with ruptured sinus of valsalva, ventricular septal defect, patent ductus arteriosus and sub aortic membrane.

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Background:  Aneurysms of the sinuses of Valsalva is a rare condition which may be a congenital or acquired cardiac anomaly with a marked male preponderance (4:1)with a a reported incidence of 1.09% in the oriental population and 0.2% in the western population, is highest in Asian population and it accounts for 1% of congenital anomalies of the heart and circulation.

Case: A case of a 25-year old female who initially presented with gradual onset of exertional dyspnea and easy fatigability. She sought consult after 11 months and a continuous murmur was noted, best heard at the left lower sternal border. Two dimensional echocardiography showed a windsock-like structure protruding into the Right ventricular outflow tract with an attached fluttering echogenic density measuring 1.39 x 0.99 cm. A mosaic color flow display is noted across the right coronary cusp draining into the RV outflow tract. Likewise, an echo drop-out is noted at the perimembanous portion of the interventricular septum measuring 0.6cm2 with mosaic color flow display across it with predominantly left to right shunt with Other significant findings include mild pulmonic stenosis, presence of subaortic membrane, dilated RV with signs of pressure and volume overload, moderate MR and TR and mild pulmonary hypertension. Blood Culture from 3 peripheral sites were taken and was positive for Streptococcus sanguinis and Staphylococcus hemolyticus and was started on Ceftriaxone, Gentamycin and Vancomycin. After the patient was cleared from bacteremia, patient underwent Repair of RCSOV and VSD double-patch repair, excision of subaortic membrane, Aortic valve replacement, reconstruction of pulmonic valve leaflet, MV repair, TV repair. There was an incidental finding of a patent ductus arteriosus measuring 1mm thus, PDA closure and LA plication were done. Post operative IOTEE showed no residual shunt across the IVS, good opening and closing motion of the prosthetic aortic valve with effective orifice area of 2cm2 with no paravalvar leak, Trivial MR and TR. Patient was then discharged in improved condition.

Conclusion: This is a rare case of 25 year old patient with ruptured coronary sinus of Valsalva (RCSOV), with associated other congenital heart disease, Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) and Subaortic Membrane who underwent repair of all lesions and had good outcome postoperatively.

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