Pulmonary Valve Endocarditis: Always Look on the (B)right Side!

Figures

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  Figure 1. Chest CT scan, axial display, demonstrates pulmonary emphysema with consolidation and air bronchogram in the right upper lobe (arrow).

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  Figure 2. Transthoracic echocardiogram on admission. Two-dimensional zoomed subcostal AV short-axis diastolic view without (A) and with (B) color-flow Doppler, demonstrates a PV mass (∗) and a broad regurgitant jet with laminar flow. (C) Continuous-wave Doppler through the PV demonstrates a dense triangular PR signal with early termination of regurgitant flow consistent with severe PR. (D) Two-dimensional apical 4-chamber diastolic view demonstrates right ventricular dilatation with a right ventricular cardiac apex. AV, Aortic valve; MPA, main pulmonary artery; RA, right atrium.

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  Figure 3. Transesophageal echocardiography before surgery. Midesophageal RVOT short-axis (60°) diastolic view (A) and transgastric biplane orthogonal long-axis (85° and 175°) diastolic views, demonstrate a PV mass (∗). LA, Left atrium; MPA, main pulmonary artery; RA, right atrium.

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  Figure 4. Three-dimensional TEE of the PV in diastole, single-beat zoom acquisition with (A) volume rendering (volume rate, 31 Hz) and (B) transillumination photorealistic displays, demonstrates the en face structure of the PV from the RVOT perspective to highlight the suspected vegetative masses (∗). Images were acquired from the transgastric RV outflow view as seen in Figure 3B.

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  Figure 5. Surgical specimen of resected PV demonstrates the extensive vegetations (arrows).