Right ventricular and septal anomalies complicated by subacute bacterial endocarditis

We report the case of a 31-year-old woman with no history of heart disease. She came to the hospital with fever dyspnea, palpitation, and edema of the lower extremities. She was found to have aortic, mitral, and pulmonary val ve insufficiency, and the initial diagnosis was subacute bacterial endocard itis. At surgery, we replaced the aortic and mitral valves with mechanical prostheses and the pulmonary valve with a bioprosthesis. The prostheses wer e soaked intraoperatively with fluconazole and the heart chambers were irri gated with povidone-iodine to prevent infection by bacteria and fungi. We a lso found 2 previously unsuspected anomalies. I was a muscular bundle that divided the right ventricle into 2 chambers, and the other was a ventricula r septal defect, 1.0 cm in diameter. We resected the muscular bundle and pa tched the septal defect. The patient had an uneventful postoperative course and was in New York Hear t Association functional class I at the 15-month follow-up visit. We specul ate that This patient's congenital anomalies made the heart more susceptibl e to damage from the endocarditis. Therefore, any patient who has infective endocarditis should also be examined closely for congenital defects.