Chonnam Med J.  2008 Aug;44(2):113-116. 10.4068/cmj.2008.44.2.113.

Delayed Rupture of Sinus of Valsalva after Infective Endocarditis: A Case Report

• Bae SY
• Choi YS
• Park EY
• Choi WY
• Cho YK
• Ma JS

• KMID: 2045760
• DOI: http://doi.org/10.4068/cmj.2008.44.2.113

Abstract

The incidence of infective endocarditis in children is 1.3 cases per 1,000 children who had been admitted. Recognizing infective endocarditis is very important because regardless of prolonged antibiotic treatment, it can entail serious complications, resulting in high morbidity and mortality. One of the important complications is the rupture of Valsalva sinus. We report a case of delayed rupture of the sinus of Valsalva in a 15-year-old boy with subarterial ventricular septal defect complicated with infective endocarditis. Physician must consider the possibility of delayed rupture of the sinus of Valsalva after infective endocarditis although initial evaluations revealed no evidence of periannular extension of infection and of perforation or rupture.

Keyword

Infective endocarditis; Ruptured sinus of Valsalva; Echocardiogram

MeSH Terms

Adolescent
Child
Endocarditis
Heart Septal Defects, Ventricular
Humans
Incidence
Rupture
Sinus of Valsalva

Figure

• 

  Fig. 1 On presentation, trans-thoracic echocardiography showed a subarterial ventricular septal defect of 3 mm diameter from parasternal long axis view.

• 

  Fig. 2 On the thirteenth day after operation, follow-up echocardiography showed ruptured sinus of Valsalva with a shunt from the aorta to the right ventricular outflow tract.

Reference

1. Parras F, Bouza E, Romero J, Buzón L, Quero M, Brito J, et al. Infectious endocarditis in children. Pediatr Cardiol. 1990. 11:77–81.

2. Fisher MC. Changing risk factors for pediatric infective endocarditis. Curr Infect Dis Rep. 2001. 3:333–336.

3. Chu CS, Sheu CC, Lee KT, Lee ST, Cheng KH, Voon WC, et al. Ruptured sinus of Valsalva and complete atrioventricular block complicating fulminant course of infective endocarditis: a case report and literature review. Kaohsiung J Med Sci. 2006. 22:398–403.

4. Shah RP, Ding ZP, Ng AS, Quek SS. A ten-year review of ruptured sinus of valsalva: clinico-pathological and echo-Doppler features. Singapore Med J. 2001. 42:473–476.

5. Bayer AS, Bolger AF, Taubert KA, Wilson W, Steckelberg J, Karchmer AW, et al. Diagnosis and management of infective endocarditis and its complications. Circulation. 1998. 98:2936–2948.

6. Pruitt AA, Rubin RH, Karchmer AW, Duncan GW. Neurologic complications of bacterial endocarditis. Medicine (Baltimore). 1978. 57:329–343.

7. Becher H, Hanrath P, Bleifeld W, Bleese N. Correlation of echocardiographic and surgical findings in acute bacterial endocarditis. Eur Heart J. 1984. 5:Suppl C. S67–S70.

8. kücükoğlu S, Ural E, Mutlu H, Ural D, Sönmez B, Uner S. Ruptured aneurysm of the sinus of Valsalva into the left ventricle: a case report and review of the literature. J Am Soc Echocardiogr. 1997. 10:862–865.

9. McMahon CJ, Ayres N, Pignatelli RH, Franklin W, Vargo TA, Bricker JT, et al. Echocardiographic presentations of endocarditis, and risk factors for rupture of a sinus of Valsalva in childhood. Cardiol Young. 2003. 13:168–172.

10. Shumacker HB Jr. Aneurysms of the aortic sinuses of Valsalva due to bacterial endocarditis, with special reference to their operative management. J Thorac Cardiovasc Surg. 1972. 63:896–902.