LEFT-VENTRICULAR RIGHT ATRIAL COMMUNICATION IN INFECTIOUS ENDOCARDITIS - DOPPLER-ECHOCARDIOGRAPHIC DIAGNOSIS

The diagnosis of a communication between the left ventricle and right atrium was made by transthoracic and transoesophageal echocardiography in a 67 year old man with a recurrence of a methicillin-resistant sta phylococcus aureus infectious endocarditis complicating aortic valve r eplacement with a bioprosthesis seven weeks previously. This diagnosis was confirmed at surgery; the left ventricular-right atrial communica tion was closed by suturing its edges and a new aortic valve prosthesi s was implanted. Unfortunately, the patient died 4 months later of myo cardial dysfunction although the infectious endocarditis seemed to hav e been sterilised by antibiotic therapy. Doppler echocardiography, esp ecially using the transoesophageal approach is the best diagnostic met hod for rare complications of infectious endocarditis, usually of the aortic valve, the prognosis of which is improved by early surgery and appropriate antibiotic therapy for the causal organims.