Bacterial Endocarditis in an Intravenous Drug User with a Ventricular Septal Aneurysm

Abstract

An aneurysm of the membranous portion of the ventricular septum (AMS) is a common complication of spontaneous ventricular septal defect closure. They have been shown to increase the incidence of cardiac pathology notably bacterial endocarditis. Because of such a severe threat, it may be an important anomaly to assess in high risk patients. A 45-year-old woman with a history of intravenous drug use presented in septic shock with end organ damage requiring intubation, broad spectrum antibiotics, and vasopressors. Physical examination displayed a 2/6 systolic ejection murmur heard loudest at the left lower sternal border. Echocardiography confirmed a mobile tricuspid vegetation; as well as, an aneurysmal deformity. During her initial history the patient stated that her VSD had been diagnosed in childhood. A cardiac catheterization showed a membranous ventricular septal aneurysm protruding from the left ventricle into the right ventricle with no evidence of ventricular septal defect. This case exemplifies a patient predisposed to endocarditis who was at higher risk due to her actions. The objective contribution of the AMS to the resultant endocarditis is unknown at this point. This sentiment raises the question if AMS detection would warrant preventative intervention for associated pathologies.