Eur J Echocardiography (2007) 8, 48e49
Atrial septal endocarditis Andrew R.J. Mitchell*, Paul Leeson, Jonathan Timperley, Saul G. Myerson, Harald Becher, Jonathan Goldman Department of Echocardiography, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom
KEYWORDS Endocarditis; Atrial septal defect; Echocardiography
Abstract Atrial septal endocarditis can occur as an isolated event or in association with valvular endocarditis. It is also reported following percutaneous device closure of atrial septal defects. We present the echocardiography findings from a young man presenting with endocarditis of an abnormal mitral valve in whom endocarditis was demonstrated associated with an atrial septal defect. ª 2007 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.
A 24-year-old man presented with a short history of fever and swollen lower limbs. Physical examination revealed signs of significant mitral regurgitation and blood cultures grew Streptococcus viridans. Transoesophageal and transthoracic echocardiography demonstrated prolapse of the mid-portion (P2) of the posterior mitral valve leaflet with severe mitral regurgitation. There was a 9 mm by 9 mm vegetation attached to the abnormal leaflet (Fig. 1). Echocardiography also identified a 10 mm secundum atrial septal defect (Fig. 2) with left to right shunting of the mitral regurgitation jet through the defect (Fig. 3). Along the inferior left atrial side of the septal defect * Corresponding author. Tel.: þ44 1865 220981; fax: þ44 1865 221432. E-mail address:
[email protected] (A.R.J. Mitchell).
were multiple small mobile masses in keeping with endocarditis of the atrial septum (Figs. 4 and 5). The patient was treated with a four-week course of antibiotics with rapid clinical improvement and resolution of the vegetations. One month later the patient underwent mitral valve repair and closure of the atrial septal defect without complication. Atrial septal endocarditis is uncommon but has been reported in patients in isolation and in association with endocarditis of other heart valves.1e4 Endocarditis of the atrial septum is also recognised following percutaneous closure of atrial septal defects.5,6 In patients presenting with valvular endocarditis it is important to consider transoesophageal echocardiography to closely examine all cardiac valves in addition to excluding co-existent congenital abnormalities.
1525-2167/$32 ª 2007 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.euje.2006.06.008
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Received 11 April 2006; received in revised form 5 June 2006; accepted 15 June 2006 Available online 28 July 2006
Atrial septal endocarditis
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Figure 1 Transoesophageal long-axis echocardiography of the mitral valve demonstrating a large vegetation attached to the posterior mitral valve leaflet LA ¼ left atrium, LV ¼ left ventricle.
Supplementary data Figure 2 Transoesophageal short-axis view at the level of the aortic valve showing the atrial septal defect (ASD). LA ¼ left atrium, RA ¼ right atrium.
Supplementary data associated with this article can be found in the online version, at 10.1016/ j.euje.2006.06.008
References
Figure 3 Apical four-chamber transthoracic echocardiography demonstrating shunting of mitral regurgitation through the atrial septal defect (ASD). LA ¼ left atrium, LV ¼ left ventricle, RV ¼ right ventricle.
1. Bush RT. Staphylococcal endocarditis with atrial septal defect. Report of a fatal case with a review of treatment. NZ Med J 1959;58:444e9. 2. Cay S, Korkmaz S. Tricuspid valve vegetation in a chronic renal failure patient with an ostium secundum type atrial septal defect after placement of a peripheral catheter. Anadolu Kardiyol Derg 2005;5(3):261. 3. Aliaga L, Santiago FM, Marti J, Sampedro A, RodriguezGranger J, Santalla JA. Right-sided endocarditis complicating an atrial septal defect. Am J Med Sci 2003;325(5):282e4. 4. Rahman A, Burma O, Felek S, Yekeler H. Atrial septal defect presenting with Brucella endocarditis. Scand J Infect Dis 2001;33(10):776e7. 5. Balasundaram RP, Anandaraja S, Juneja R, Choudhary SK. Infective endocarditis following implantation of amplatzer atrial septal occluder. Indian Heart J 2005;57(2):167e9. 6. Bullock AM, Menahem S, Wilkinson JL. Infective endocarditis on an occluder closing an atrial septal defect. Cardiol Young 1999;9(1):65e7.
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Figures 4 and 5 Transoesophageal view of the atrial septum showing vegetations along the left atrial surface of the septum. ASD ¼ atrial septal defect, LA ¼ left atrium, RA ¼ right atrium.
