title: Are all ventricular septal defects created equal?
abstract: The authors report the occurrence of infective endocarditis in a 32-year-old man with a ventricular septal defect and a left ventricular-to-right-atrial shunt who adhered to the revised 2007 American Heart Association guidelines for infective endocarditis. The patient had received antibiotic prophylaxis prior to multiple previous dental procedures. At a recent dental evaluation for fillings, he was informed that he no longer needed prophylaxis. Fatigue and fevers developed 1 week later, and he was treated with an oral course of ciprofloxacin. The symptoms recurred, and blood cultures grew Streptococcus viridans. A 7-mm vegetative mass was seen on the septal leaflet of the tricuspid valve during transesophageal echocardiography. This report raises the concern that patients with ventricular septal defects and left ventricular-to-right-atrial shunts are at higher risk for endocarditis and may require antibiotic prophylaxis.
authors.affiliation: Department of Pediatrics and the Steele Children's Research Center, Division of Pediatric Cardiology, University of Arizona, Tucson, Arizona 85724-5073, USA. dlax@peds.arizona.edu
authors.forename: Daniela
authors.initials: D
authors.lastname: Lax
authors.forename: Rajan D
authors.initials: RD
authors.lastname: Bhatt
authors.forename: Scott E
authors.initials: SE
authors.lastname: Klewer
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Sorrell
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D015150:Echocardiography, Doppler; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000000981:diagnostic imaging; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male