Key result
Huge LV pseudoaneurysm from suspected infective endocarditis causes fatal refractory shock despite aggressive medical therapy.
Why the study?
Cases of infective endocarditis presenting primarily as a huge left ventricular pseudoaneurysm are rarely reported in the literature.
Case Report (n=1)
Infective endocarditis can rarely present as a huge left ventricular pseudoaneurysm, posing a diagnostic dilemma and carrying a high mortality risk if surgical intervention is not pursued.
Answers are grounded in this paper and cite their sources.
High mortality in young adults with LV pseudoaneurysm from IE cautions against delayed diagnosis; leaves open optimal surgical timing in similar cases.
Cases of infective endocardits presenting per se as huge LV PA are rarely reported in the literature. A 30-year-old male with no cardiac risk factors presented with community-acquired pneumonia and sepsis and shock. Chest X-ray revealed bilateral consolidation. A huge bulge was noted on the left ventricular border. Electrocardiogram did not reveal any ischemia or infarction. A transthoracic echocardiogram showed an aneurysm-like structure communicating with the left ventricle free wall below the mitral valve suggestive of LV pseudoaneurysm with severe mitral regurgitation. This was confirmed by a computed tomography scan. No vegetation was noted. He was treated aggressively with intravenous broad-spectrum antibiotics and inotropes but was in persistent shock. Cardiac surgery was considered, but the patient and relatives refused. Finally, he went into refractory shock and expired. The dilemma was the cause for this presumably acute-onset PA. There was no clear-cut evidence of endocarditis, though this appears to be the etiology in this patient.
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Hasan et al. (2019) conducted a case report in Left ventricular pseudoaneurysm (n=1). Intravenous broad-spectrum antibiotics and inotropes was evaluated. A 30-year-old male with a huge left ventricular pseudoaneurysm, presumably due to infective endocarditis, presented with refractory shock and expired despite aggressive medical therapy.
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