# A Rare Case of Sinus of Valsalva Aneurysm Rupture Resulting From Infective Endocarditis and Requiring Surgery

## TL;DR

A rare case of a two-year-old boy with heart defects and atopic dermatitis developed a severe heart infection leading to a life-threatening rupture requiring surgery.

## Contribution

Highlights the role of atopic dermatitis in increasing infective endocarditis risk and the importance of proactive skin care in congenital heart disease patients.

## Key findings

- Atopic dermatitis likely served as a portal for Staphylococcus aureus entry leading to infective endocarditis.
- Surgical repair was necessary for a ruptured sinus of Valsalva aneurysm caused by infective endocarditis.
- Proactive skin care and close monitoring are critical for preventing severe infections in congenital heart disease patients with atopic dermatitis.

## Abstract

Infective endocarditis (IE) is a life-threatening infection. Although some cases with early diagnosis are treated with antibiotics only, others are associated with intracardiac complications and/or sepsis, necessitating intensive care and surgical repair. Congenital heart disease (CHD) and atopic dermatitis (AD) are risk factors for IE, with AD being a common comorbidity in children with CHD-related IE due to impaired skin barrier function. In the present case, the patient’s untreated AD compromised his skin integrity, serving as a portal for Staphylococcus aureus entry, which was subsequently isolated from blood cultures. We report a rare case of IE with sinus of Valsalva aneurysm rupture (SoVR) requiring surgical repair. A two-year-old boy with a ventricular septal defect and AD was referred to our hospital for IE with sepsis. Blood culture was positive for methicillin-susceptible Staphylococcus aureus. The patient entered the intensive care unit (ICU), and antibiotic administration was started. Transthoracic echocardiography (TTE) showed a vegetation and SoVR with perforation of the right coronary cusp, leading to an aorta-to-right ventricle shunt. On the 11th day after admission, TTE showed dilatation of the ruptured sinus of Valsalva and exacerbation of the aorta-to-right shunt. Surgical repair was performed on the same day. The postoperative course went well, and the patient was extubated on postoperative day (POD) five and discharged from the ICU on POD nine. TTE showed trivial aortic regurgitation and diminished aorta-to-right ventricle shunt. Antibiotics were discontinued one month after admission. The patient was discharged from our hospital on the 40th day after admission. In this case, the underlying AD likely contributed to the IE by serving as an entry point for S. aureus. Close follow-up and systemic management, always with surgical treatment in mind, were important for determining the timing of surgical intervention. Clinicians should also recognize the role of AD in increasing IE risk and emphasize proactive skin care for CHD patients to prevent severe infections.