https://orcid.org/0000-0003-4069-4177
An 84-year-old man was admitted to the infectious diseases department with low-grade fever, positive blood cultures for Candida Albicans, and ocular septic event. Twenty-one years earlier, he was subjected to an endoventricular patch repair (Dor operation) to exclude an apical aneurysm of the left ventricle (LV), due to an occlusion of the anterior descending coronary artery. Transthoracic echocardiography showed an apical LV aneurysm measuring 40 × 27 mm, combined with a suspected LV pseudoaneurysm measuring 16 × 7 mm at the lateral apex. It confirmed a dacron patch that was used to close the large aneurysmatic orifice (Panel A, see Supplementary data online, Videos S1 and S2). Patch degeneration with three perforations was demonstrated on colour Doppler images, due to the presence of a back-and-forth flow through the patch (Panels B and C, see Supplementary data online, Videos S3 and S4). A focused image showed small oscillating echogenic masses attached to the implanted intracardiac material suspected for vegetation, with the bigger one (measuring 5 × 7 mm) close to the central hole (Panel D, see Supplementary data online, Video S5). Transoesophageal echocardiography excluded valvular endocarditis. Computed tomography confirmed the LV pseudoaneurysm, which was connected to the LV apical aneurysm (Panel E). 18F-fluorodeoxyglucose positron emission tomography showed heterogeneous high-intensity apical uptake, consistent with periprosthetic infection (Panel F). The patient was treated medically due to high surgical risk related to cerebral haemorrhage. Our case describes an endoventricular patch mycotic endocarditis complicated by an infected pseudoaneurysm and underscores that multimodality imaging plays an indispensable role in definite diagnosis.
Supplementary data are available at European Heart Journal - Cardiovascular Imaging online.
Funding: This research received no external funding.
Data availability: The data underlying this article will be shared on reasonable request to the corresponding author.
Author notes
Conflict of interest: None declared.
