# A Rare Case of Ventricular Septal Defect and Double-Chambered Right Ventricle With Bilateral Cardiac Infective Endocarditis

## TL;DR

A 41-year-old patient with a rare heart defect and bilateral endocarditis was successfully treated with surgery and antibiotics.

## Contribution

This paper presents a rare case of bilateral endocarditis in a patient with a ventricular septal defect and double-chambered right ventricle.

## Key findings

- The patient had vegetations on multiple heart valves and a small VSD with left-to-right shunt.
- Surgical valve replacement and VSD closure led to successful postoperative recovery.
- The case highlights the need for endocarditis prophylaxis in patients with intracardiac shunts.

## Abstract

Infective endocarditis (IE) typically affects the left side of the heart. Multiple valve involvement on both sides of the heart is a rare occurrence. However, congenital heart defects, particularly ventricular septal defects (VSD), can predispose individuals to bilateral endocarditis. We present a case of a 41-year-old patient with congenital VSD and double-chambered right ventricle (DCRV) who presented with fever, generalized fatigue, and unintentional weight loss of 20 kg over two months. Transthoracic echocardiography revealed vegetations on the aortic valve, pulmonary valve, and right ventricular outflow tract (RVOT), alongside a small VSD with left-to-right shunt. The blood cultures revealed Streptococcus mutans. Initially, the patient was treated with intravenous antibiotics. In the further course, she showed persistent symptoms and signs of sepsis and failure of vegetation regression. The decision was made for surgical intervention. The aortic valve was replaced with a mechanical valve (St. Jude Medical Regent, 23 mm, Saint Paul, Minnesota, United States), and the pulmonary valve was replaced with a tissue valve (Medtronic Freestyle, 27 mm, Minneapolis, Minnesota, United States). The VSD was closed directly, and the fibromuscular tissue causing DCRV was resected. The postoperative recovery was uneventful, and the patient was discharged in stable general condition. This case emphasizes the importance of considering congenital heart defects in patients with bilateral endocarditis, highlighting the need for comprehensive preoperative echocardiographic evaluation and intraoperative assessment. Endocarditis prophylaxis should be strongly considered for patients with intracardiac shunts, particularly during dental procedures involving the disturbance of the gingival tissue, the periapical region of teeth, or the oral mucosa.