Key result
Optimal medical therapy fails to prevent death from massive inoperable LV pseudoaneurysm complicating infective endocarditis.
Case Report (n=1)
No
Demonstrates the fatal natural history of an inoperable large left ventricular pseudoaneurysm complicating infective endocarditis in an IV drug user.
Documents rapid fatal progression of inoperable LV pseudoaneurysm post-endocarditis; confirms high mortality and leaves open optimal intervention timing.
Infective endocarditis is a severe and now more frequently encountered condition given the rise of intravenous (IV) drug use. An IV drug user presented with septic shock and bacterial endocarditis. Upon imaging, a fistulous tract was discovered, communicating from the annulus of the infected mitral valve to a large left ventricular pseudoaneurysm (PA). Presence of valvular vegetation, heart failure, and PA are all independent factors of increased mortality rates. The sheer size of the PA placed this patient at a very high surgical risk, and she was deemed inoperable. She was discharged when stabilized on supportive medical therapy. However, she returned six weeks later in cardiogenic shock with multi-organ failure. Repeat imaging revealed that the PA had significantly increased in size. Despite optimal medical management, the patient's condition deteriorated, and she, unfortunately, succumbed to her illness.
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Bhagat et al. (2018) conducted a case report in Infective endocarditis and left ventricular pseudoaneurysm (n=1). Conservative medical management was evaluated. A 40-year-old female intravenous drug user with infective endocarditis developed a massive, inoperable left ventricular pseudoaneurysm and ultimately died despite optimal medical management.
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