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Cardiovascular Images

Endocarditis After Pectus Excavatum Repair

A Case Report

C. Jerry Jou, DO, PhD; Phillip T. Burch, MD; Christopher R. Mart, MD; Linda M. Lambert, PNP; Peter C. Kouretas, MD, PhD and L. LuAnn Minich, MD

From the Primary Children’s Medical Center, Salt Lake City, Utah.

Correspondence to C. Jerry Jou, DO, PhD, Primary Children’s Medical Center, Department of Pediatric Cardiology, 100 Mario Capecchi Drive, Salt Lake City, Utah 84113-1103. E-mail jerry_jou@hotmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Pectus excavatum is a common congenital musculoskeletal disease occurring in approximately 1 in 800 births.¹ Indications for surgical repair include pain, exercise intolerance, abnormal pulmonary function, right ventricular (RV) dysfunction, tricuspid valve compression, and cosmetic enhancement.² We present an unusual case of endocarditis after pectus repair.

A 14-year-old girl presented to the emergency room with a 2-week history of intermittent fever, chills, and pain in the lower parasternum 2 months after pectus excavatum repair. The modified Ravitch technique was used, inserting an 18-cm vitallium strut for stabilization. Physical examination revealed a 3/6 holosystolic midfrequency murmur heard throughout the precordium and an early, short diastolic murmur. Initial laboratory studies demonstrated a mild left shift and elevated inflammatory markers. Chest radiograph demonstrated a normal cardiac silhouette with inferior and posterior displacement of the pectus bar at the level of the RV anterior wall (Figures 1 and 2). The findings from the ECG were normal. A nuclear medicine white blood cell scan demonstrated nonspecific abnormal increased radiotracer uptake in the mediastinum.

View larger version (78K):   Figure 1. Chest radiograph in the anteroposterior (A) and lateral projection (B) before displacement of the pectus bar.

 

View larger version (80K):   Figure 2. Chest radiograph in the anteroposterior (A) and lateral projection (B) after displacement of the pectus bar.

 
The initial transthoracic echocardiogram demonstrated shadowing in the RV with mild compression of the RV outflow tract (Figure 3; Movie I). Repeat transthoracic and transesophageal echocardiograms 48 hours later demonstrated the presence of a large mobile mass in the RV outflow with . . . [Full Text of this Article]