P327 PULMONARY EMBOLISM FROM RIGHT–SIDED VALVE ENDOCARDITIS REVEALING RECTAL NEOPLAS. A “LUCKY” CASE

Abstract

Abstract We describe a case of a 64–years–old man, outwardly healthy, presented with dyspnoea for 2–3 months and weight loss, coincident Co–Vid. Lung CT scan showed massive PULMONARY EMBOLISM. Echocardiography showed LONE PULMONARY VALVE INFECTIVE ENDOCARDITYS with large mobyle vegetations swinging between RVOT and pulmonary artery. Streptococcus Gallolyticus was identified on blood culture (often related with colorectal neoplasm). Given targeted antibiotic therapy, a surgical opinion was obtained: advised trial of medical management. Patient underwent a colonscopy, because of the causing germ: a neoplasm of rectal posterior side was found, hystological examination revealed an adenocarcinoma. MNR demonstrated a solid rectal lesion protruding in the lumen, infiltrating muscle and adipose tissue, but not pelvic organs. Team discussion with surgeons and oncologists: indication at neoadjuvant therapy before heart valve surgery. After 12 days of antibiotics a new TOE and CT scan were performed and revealed enlargement of valvular vegetations with severe pulmonary regurgitation and also PE warsened. After new surgical opinion, has been given indication of valve replacement. A Magna Ease bioprostetic valve was implanted; the native valve appeared completely destroyed and histological exam showed white fragments including cusps, granulocytes and bacteria, no growth at the culture. No complications obseved in the post operative period, regular echo follow up. The patient underwent neoadjuvant therapy and then surgery to remove the colorectal mass. Lone pulmonary valve infective endocarditis is a rare disease (1–2%), especially without history of immunodeficiency or drug abuse, we should look for a cause of persistent bacteraemia. Bacteraemia is a frequent condition in presence of colorectal neoplasm or IBD, mostly enterococchi or S.Gallolitycus. Septic pulmonary embolism is a frequent complication. Following guidelines, surgery should be considered only if there is no response to antibiotic therapy, extended tricuspid valve vegetations, recurrent pulmonary embolism. Valve vegetations> 10mm are predictor of poor response to ab therapy and pulmonary embolism.