Case Report
Are All Ventricular Septal Defects Created Equal?

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The authors report the occurrence of infective endocarditis in a 32-year-old man with a ventricular septal defect and a left ventricular–to–right-atrial shunt who adhered to the revised 2007 American Heart Association guidelines for infective endocarditis. The patient had received antibiotic prophylaxis prior to multiple previous dental procedures. At a recent dental evaluation for fillings, he was informed that he no longer needed prophylaxis. Fatigue and fevers developed 1 week later, and he was treated with an oral course of ciprofloxacin. The symptoms recurred, and blood cultures grew Streptococcus viridans. A 7-mm vegetative mass was seen on the septal leaflet of the tricuspid valve during transesophageal echocardiography. This report raises the concern that patients with ventricular septal defects and left ventricular–to–right-atrial shunts are at higher risk for endocarditis and may require antibiotic prophylaxis.

Section snippets

Case Presentation

We report an occurrence of infective endocarditis in a patient with a ventricular septal defect (VSD) who adhered to the revised 2007 American Heart Association (AHA) and American College of Cardiology (ACC) guidelines for infective endocarditis.1

The patient was a 32-year-old male health care worker with a VSD who carefully complied with the AHA's endocarditis recommendations. He is followed by a primary care physician and received antibiotics prior to multiple previous dental procedures,

Discussion

VSD is a common congenital heart defect, accounting for approximately 10% of all congenital heart disease. The incidence of infective endocarditis in patients with VSDs is rare, with an average rate of 16 per 10,000 patient-years (range, 3-38 per 10,000 patient-years).2, 3 VSDs with LV-RA shunts are reported to be associated with a higher risk for endocarditis (58 per 10,000 patient-years) compared with typical VSDs4 or mitral regurgitation (5.2 per 10,000 patient-years).5

The necessary

Acknowledgment

This work was supported in part from the Allan C. Hudson and Helen Lovaas Endowed Chair of Cardiac Imaging (V.L.S.).

References (6)

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This work was supported in part from the Allan C. Hudson and Helen Lovaas Endowed Chair of Cardiac Imaging (V.L.S.).

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