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• W2003236412 abstract "HomeCirculationVol. 119, No. 6Right Ventricular Mural Bacterial Endocarditis Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBRight Ventricular Mural Bacterial EndocarditisVegetations Over Moderator Band Alummoottil George Koshy, DM, Babu Kanjirakadavath, MD, DNB, Radhakrishnan Vallikkattu Velayudhan, DM, Mohammed Sali Subair Kunju, DNB, Preetham Kumar Francis, MD, Abdul Rasheed Mohammed Haneefa, MCh, Rajasekharan Vellannure Rajagopalan, MCh and Suresh Krishnan, DM Alummoottil George KoshyAlummoottil George Koshy From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author , Babu KanjirakadavathBabu Kanjirakadavath From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author , Radhakrishnan Vallikkattu VelayudhanRadhakrishnan Vallikkattu Velayudhan From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author , Mohammed Sali Subair KunjuMohammed Sali Subair Kunju From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author , Preetham Kumar FrancisPreetham Kumar Francis From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author , Abdul Rasheed Mohammed HaneefaAbdul Rasheed Mohammed Haneefa From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author , Rajasekharan Vellannure RajagopalanRajasekharan Vellannure Rajagopalan From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author and Suresh KrishnanSuresh Krishnan From the Departments of Cardiology (A.G.K., B.K., R.V.V., M.S.S.K., P.K.F., S.K.) and Thoracic and Cardiovascular Surgery (A.R.M.H., R.V.R.), Government Medical College Hospital, Thiruvananthapuram, India. Search for more papers by this author Originally published17 Feb 2009https://doi.org/10.1161/CIRCULATIONAHA.108.799072Circulation. 2009;119:899–901A 40-year-old man who was a smoker with no history of intravenous drug use presented to a tertiary hospital with a week-long high-grade fever, dry cough, and streaky hemoptysis. He had hypoxia at room air. Chest x-ray showed bilateral ground-glass opacities with relative sparing of apexes and left base (Figure 1). Download figureDownload PowerPointFigure 1. Initial bilateral ground-glass opacities with relative sparing of apexes and left base.Sputum and blood cultures (including fungal) and HIV tests were negative. He had received intravenous piperacillin and tazobactam empirically for a week, with fair clinical improvement and resolution of radiological shadows. He was referred to our tertiary center for further management. Ocular fundi had multiple preretinal hemorrhages, a few with central clearing (Figure 2). Download figureDownload PowerPointFigure 2. Roth’s spots (preretinal hemorrhages).Transthoracic echocardiogram revealed a bilobed, oscillating, 2×1.5-cm right ventricular mass with peduncle arising from the anterior end of the moderator band (Figure 3A and Movie I of the online Data Supplement). Download figureDownload PowerPointFigure 3. A, Transthoracic echocardiographic 4-chamber view showing a bilobed, oscillating, 2×1.5-cm right ventricular mass with peduncle arising from the anterior end of the moderator band. B, Transesophageal echocardiographic image of the mass (modified 4-chamber midesophageal zoomed view).Transesophageal echocardiogram (Figure 3B and Movie II) showed a 2-mm patent foramen ovule, and all valves were normal. The mass was visualized in a modified 4-chamber midesophageal view. Sixty-four–slice computed tomography pulmonary angiography showed no filling defects in the pulmonary artery. Cardiac magnetic resonance imaging (Figure 4 and Movie III) showed the contrast-nonenhancing mass and confirmed a structurally normal heart. His blood cultures were negative even after prolonged culture. He was started on empirical endocarditic therapy with vancomycin and gentamicin on suspicion of the mass being infective vegetation. Because the fever continued beyond a week of antibiotics, the decision to remove the mass was made. Download figureDownload PowerPointFigure 4. Cardiac magnetic resonance 4-chamber white blood true fast imaging with steady-state precession image of the mass. Heart is structurally normal.He underwent right atriotomy under cardiopulmonary bypass. The right ventricle and tricuspid valve were normal. A linear 2×0.5-cm pale white growth and a smaller 0.5×0.5-cm pale gray growth that were loosely attached to the moderator band were noted and removed. Right ventricular endothelium was normal throughout, and excision of the moderator band was not done.Histopathological examination showed fibrinous material with predominantly neutrophilic infiltrates (Figure 5) and Gram-positive cocci (Figure 6). Culture of specimen yielded Staphylococcus aureus sensitive to methicillin and gentamicin. Hence, oxacillin and gentamicin were continued for another 2 weeks. The patient became afebrile, and C-reactive protein values were normalized. He was doing well at the 1-year follow-up visit. Download figureDownload PowerPointFigure 5. Fibrinous material with neutrophilic and eosinophilic infiltrate.Download figureDownload PowerPointFigure 6. Cluster of Gram-positive cocci in a fibrinous nest.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/119/6/899/DC1.We acknowledge M. Balaraman Nair, Department of Histopathology, Doctors’ Diagnostic and Research Centre, Thiruvanathapuram; C.S. Sheeba, Department of Ophthalmology, Regional Institute of Ophthalmology, Thiruvanathapuram; and T.R. Kapilamoorthy, Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanathapuram.DisclosuresNone.FootnotesCorrespondence to Dr A. George Koshy, Cardiologist, TC 4/2559 (1), Kowdiar, Thiruvananthapuram, Kerala, India 695003. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Halder V, Gourav K, Negi S, Biswas I and Azmeera S (2021) Sub‐pulmonic stenosis caused by a right ventricular outflow tract vegetation in a children with restricted ventricular septal defect , Journal of Clinical Ultrasound, 10.1002/jcu.23005, 49:9, (936-939), Online publication date: 1-Nov-2021. Wu W, Ye S and Chen G (2018) Right-sided infective mural endocarditis complicated by septic pulmonary embolism and cardiac tamponade caused by MSSA, Heart & Lung, 10.1016/j.hrtlng.2018.05.010, 47:4, (366-370), Online publication date: 1-Jul-2018. Levasseur S and Saiman L (2018) Endocarditis and Other Intravascular Infections Principles and Practice of Pediatric Infectious Diseases, 10.1016/B978-0-323-40181-4.00037-2, (261-270.e3), . Xu B, Harb S, Rodriguez L, Rodriguez E and Kalahasti V (2017) Comprehensive Echocardiographic Evaluation of an Atypical Left Ventricular Mass with an Unusual Site of Attachment, CASE, 10.1016/j.case.2016.11.002, 1:2, (54-58), Online publication date: 1-Apr-2017. Tahara M, Nagai T, Takase Y, Takiguchi S, Tanaka Y, Kunihara T, Arakawa J, Nakaya K, Hamabe A, Gatate Y, Kujiraoka T, Tabata H and Katsushika S (2017) Primary Mural Endocarditis Without Valvular Involvement, Journal of Ultrasound in Medicine, 10.7863/ultra.16.03049, 36:3, (659-664), Online publication date: 1-Mar-2017. Jawad M and Cardozo S (2015) RVOT mural and mitral valve endocarditis: A case report, Indian Heart Journal, 10.1016/j.ihj.2015.09.009, 67:6, (595-597), Online publication date: 1-Nov-2015. Adel A, Jones E, Johns J, Farouque O and Calafiore P (2014) Bacterial Mural Endocarditis. A Case Series, Heart, Lung and Circulation, 10.1016/j.hlc.2014.03.026, 23:8, (e172-e179), Online publication date: 1-Aug-2014. Vinod G, Kanjirakadavath B and Krishnan M (2013) Large mural vegetation from right ventricle, accompanying tricuspid valve endocarditis, Heart Asia, 10.1136/heartasia-2013-010335, 5:1, (82-83), . Levasseur S and Saiman L (2012) Endocarditis and Other Intravascular Infections Principles and Practice of Pediatric Infectious Diseases, 10.1016/B978-1-4377-2702-9.00037-4, (256-265.e4), . February 17, 2009Vol 119, Issue 6 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.799072PMID: 19221233 Originally publishedFebruary 17, 2009 PDF download Advertisement SubjectsComputerized Tomography (CT)EchocardiographyValvular Heart Disease" @default.
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