Ventricular Septal Perforation Caused by Right-Sided Infective Endocarditis Associated With Giant Vegetation

Abstract

A 71-year-old man presented with general fatigue associated with syncope and fever, and was admitted to our hospital and treated with antibiotics for pneumonia. On day 10 after admission, cardiac echocardiography showed a ventricular septal perforation and giant vegetation floating in the right ventricle near the tricuspid valve, which had not been detected at the time of admission. An emergency operation (including vegetation excision, debridement, ventricular septal perforation patch closure, and tricuspid valve replacement) was performed. A permanent pacemaker was implanted on postoperative day 34, and the patient was discharged without any complications. A culture of the excised vegetation and blood culture revealed methicillin-susceptible Staphylococcus aureus. There has been no previous report of a presenting ventricular septal perforation caused by right-sided infective endocarditis.