Key result
Ceftriaxone for 8 weeks resolves a VSD-margin vegetation in a case of unrepaired ToF.
Case Report (n=1)
In pressure-equalized nonrestrictive VSDs, vegetation may follow flow geometry rather than the classical jet-lesion pattern, requiring multiplane inspection of both VSD margins.
Raises awareness for IE in unrepaired TOF; leaves open optimal management strategies in complex adult congenital heart disease.
CASE SUMMARY: A 39-year-old woman with unrepaired tetralogy of Fallot had a mobile vegetation on the left ventricular septal surface of a nonrestrictive ventricular septal defect (VSD) on transthoracic echocardiography; transesophageal echocardiography corroborated it in 2 distinct planes. Three blood-culture sets grew a β-hemolytic streptococcus (presumptive Streptococcus pseudoporcinus); imaging plus positive cultures established definite infective endocarditis. Eight weeks of ceftriaxone achieved echocardiographic resolution; she remained asymptomatic at 6 months. TAKE-HOME MESSAGE: In pressure-equalized nonrestrictive VSDs, vegetation may follow flow geometry rather than the classical jet-lesion pattern; multiplane inspection of both VSD margins is essential.
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Moujabber et al. (2026) conducted a case report in Unrepaired tetralogy of Fallot with infective endocarditis (n=1). Ceftriaxone was evaluated on Echocardiographic resolution. Eight weeks of ceftriaxone achieved echocardiographic resolution of a left ventricular VSD-margin vegetation in a 39-year-old woman with unrepaired tetralogy of Fallot.
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