Ventricular septal fistula formation due to infectious endocarditis in a hemodialysis patient with aortic valve replacement |
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Authors: | S Horita T Shinoda H Yoshimoto M Masuo Y Miura |
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Institution: | (1) Department of Medicine, Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan, JP;(2) Department of Medicine, Social Insurance Chuo General Hospital, 3-22-1 Hyakunin-cho, Shinjuku-ku, Tokyo 169-0073, Japan Tel. +81-3-3364-0251; Fax +81-3-3364-5663 e-mail: shinodatmd@par.odn.ne.jp, JP |
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Abstract: | We report a case of infectious endocarditis in a 77-year-old woman who was undergoing maintenance hemodialysis therapy, and
who was also having a prosthetic aortic valve replacement. The disease resulted from a local skin infection at the needle
puncture site of the arteriovenous fistula. Ampicillin-resistant Staphylococcus aureus was the causal organism. Surgical treatment could not be performed because of associated intracranial hemorrhage due to septic
embolism. In spite of intensive treatment with several antibiotics, a ventricular septal abscess just beneath the prosthetic
aortic valve progressed to form a ventricular septal fistula. The resultant intracardiac left-to-right shunt led to refractory
congestive heart failure. The patient finally died of heart failure. The formation of a ventricular septal fistula is considered
to be a rare and extraordinary complication of infectious endocarditis in a hemodialysis patient with aortic valve replacement.
Received: July 25, 2001 / Accepted: November 3, 2001 |
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Keywords: | Hemodialysis Infectious endocarditis Prosthetic aortic valve Ventricular septal fistula |
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