[Left ventricle-right atrium communications acquired in bacterial endocarditis].
Three cases of acquired LV-RA communication during bacterial endocarditis are reported. The causal organisms were Staphylococcus aureus and Streptococcus. The endocarditis complicated aortic valve disease in 2 patients and a congenital aneurysm of the membranous interventricular septum in the third case. Perforation of the septal abscess was preceded by 1st and 2nd degree AVB in all cases associated with bursts of intrahisian tachycardia in 1 case. The clinical presentation was that of an acute VSD; LV-RA communication was diagnosed by the radiological demonstration of systolic expansion of the RA, by 2D echocardiography using constant and Doppler techniques which gave the exact diagnosis in 1 case, by oximetry showing a large left-to-right shunt situated in the RA, and finally by selective left ventriculography. Surgery is essential and urgent and comprises repair of the fistula by two patches, one atrial shown on via a right atrial approach and the other ventricular via aortotomy associated with correction of the valvular lesions. Third degree AVB is observed in all cases, due to the anatomical location of the His bundle and requires permanent pacing. Good results were observed in 2 cases with follow-up periods of 14 and 48 months respectively.
D000208:Acute Disease; D000328:Adult; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004452:Echocardiography; D004630:Emergencies; D004697:Endocarditis, Bacterial / Q000150:complications*; D006346:Heart Septum; D006801:Humans; D008297:Male; D008875:Middle Aged
Communications ventricule gauche-oreillette droite acquises au cours des endocardites bactériennes.