Abstract
IntroductionRheumatic and congenital heart diseases account for the majority of hospital admissions for cardiac patients in India. Tetralogy of Fallot is the most common congenital heart disease with survival to adulthood. Infective endocarditis accounts for 4% of admissions to a specialized unit for adult patients with a congenital heart lesion. This report is unique in that a severe stenotic lesion of the mitral valve, probably of rheumatic aetiology, was noted in an adult male with Tetralogy of Fallot.Case presentationAn unusual association of rheumatic mitral stenosis in an adult Indian male patient aged 35 years with Tetralogy of Fallot and subacute bacterial endocarditis of the aortic valve is presented.ConclusionIn this case report the diagnostic implications, hemodynamic and therapeutic consequences of mitral stenosis in Tetralogy of Fallot are discussed. In addition, the morbidity and mortality of infective endocarditis in adult patients with congenital heart disease are summarized. The risk of a coincident rheumatic process in patients with congenital heart disease is highlighted and the need for careful attention to this possibility during primary and follow-up evaluation of such patients emphasized.
Highlights
Rheumatic and congenital heart diseases account for the majority of hospital admissions for cardiac patients in India
We discuss an interesting association of rheumatic mitral stenosis in an adult with tetralogy of Fallot (TF) complicated by infective endocarditis of the aortic valve
Aortic regurgitation may occur in affected patients in or beyond the second decade of life, and this may predispose to infective endocarditis [4]
Summary
There was no definitive evidence of prior streptococcal infection, the clinical profile and the echocardiographic findings suggest an acquired rheumatic etiology in our patient. Histologic evidence of active rheumatic carditis (noted in up to 40% of patients with unexplained heart failure), raised http://www.jmedicalcasereports.com/content/2/1/127 antistreptolysin O titers and absence of other features of carditis support this contention [10]. These arguments favor a rheumatic etiology for the mitral stenosis in our case. This report draws attention to an interesting association of rheumatic mitral stenosis in TF and highlights the possibility of a coexistent rheumatic lesion in patients with congenital heart disease
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