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Spontaneous bacterial endocarditis and aortic valve replacement complicating pregnancy
Imcnuhnl~ll
GYNECOLOGY
& OBSTETRICS
International Journal of Gynecology & Obstetrics 54 (1996) 173-174
Brief communication
Spontaneous bacterial endocarditis and aortic valve replacement complicating pregnancy G.D. Hautman, S.J. Sherman* Department of Obstetrics and Gynecology, St John Hospital and Medical Center, Detroit, MI, USA Received 28 December 1995;revised 25 March 1996;accepted 27 March 1996
Keywordr: Bacterial
endocarditis;Aortic valve replacement
Our patient is a 31-year-old gravida III para II ab I who presented with a fever of 10 days’ duration, back pain, shortness of breath and cough. The patient had delivered a female infant vaginally 13 days previously. She had received an epidural anesthetic for analgesia during labor and had had an elevation of temperature to 1005°F. Immediately postpartum her blood pressure was noted to be slightly elevated to 134153mmHg and 146150 mmHg, with subsequent normotensive blood pressures.Significant laboratory studies revealed a urinalysis with occasional bacteria and a culture which was negative for infection. Blood cultures were negative for evidence of infection. The patient had been treated at home with oral erythromycin for 3 days becauseof her cough, but without improvement. On admission, the patient’s vital signs were: temperature 99.7”F, pulse 93 beats/mm, blood pressure 13l/38 mmHg and respirations 16 breaths/mm. Physical examination
l Corresponding author, Tel.: +I 313 3437798;Fax: +l 313 3434932.
was notable for a grade-II systolic ejection murmur at the left upper sternal border as well as a grade-II diastolic murmur at the right upper sternal border. The patient was started on an intravenous antibiotic regimen of clindamycin, gentamicin and vancomycin. An echocardiogram did not demonstrate any vegetations but did show severe aortic insufficiency and possible mitral regurgitation. On the 4th day of admission the patient developed congestive heart failure. She underwent cardiac catheterization which demonstrated normal pulmonary artery pressures, a severely elevated left ventricular end-diastolic pressure, mild-tomoderate systolic dysfunction with a dilated left ventricle, severe aortic regurgitation and normal coronary arteries. A transesophageal echocardiogram was performed showing vegetations on the aortic valve, destruction of the aortic valve and a cavity right beneath the aortic valve between the aortic valve and the anterior mitral leaflet. The patient underwent an aortic valve replacement with a no. 21 St Jude valve without complication. Findings at surgery included a large vegetation on the
0020-7292/96/$.15.000 1996 International Federation of Gynecology and Obstetrics PII: SOO20-7292(96)02687-2
114
G.D. Hautman, S.J. Sherman/International
Journal of Gynecology & Obstetrics 54 (1996) 173-174
left coronary cusp, severedamage to the cusp and a large cavity measuring 3 x 1.5 cm deep beneath the left coronary cusp and anterior leaflet of the mitral valve. She was discharged home on day 50 in good condition. Although bacterial endocarditis is an extremely rare diagnosis in pregnancy and puerperium it is important to keep it in the differential diagnosis when puerperal fever is present [ 1,2]. Rapid detection and appropriate treatment of this condition
will result in very low maternal and fetal morbidity and mortality. References 111 Payne DG, Fishbume JI, Rufty AJ, Johnson F. Bacterial
endocarditis in pregnancy. Obstet Gynecol 1982; 60: 247-250.
PI Seaworth BJ, Durack DT. Infective endocarditis in
obstetric and gynecologic practice. Am J Obstet Gynecol 1986; 154: 180-188.
GYNECOLOGY
& OBSTETRICS
International Journal of Gynecology & Obstetrics 54 (1996) 173-174
Brief communication
Spontaneous bacterial endocarditis and aortic valve replacement complicating pregnancy G.D. Hautman, S.J. Sherman* Department of Obstetrics and Gynecology, St John Hospital and Medical Center, Detroit, MI, USA Received 28 December 1995;revised 25 March 1996;accepted 27 March 1996
Keywordr: Bacterial
endocarditis;Aortic valve replacement
Our patient is a 31-year-old gravida III para II ab I who presented with a fever of 10 days’ duration, back pain, shortness of breath and cough. The patient had delivered a female infant vaginally 13 days previously. She had received an epidural anesthetic for analgesia during labor and had had an elevation of temperature to 1005°F. Immediately postpartum her blood pressure was noted to be slightly elevated to 134153mmHg and 146150 mmHg, with subsequent normotensive blood pressures.Significant laboratory studies revealed a urinalysis with occasional bacteria and a culture which was negative for infection. Blood cultures were negative for evidence of infection. The patient had been treated at home with oral erythromycin for 3 days becauseof her cough, but without improvement. On admission, the patient’s vital signs were: temperature 99.7”F, pulse 93 beats/mm, blood pressure 13l/38 mmHg and respirations 16 breaths/mm. Physical examination
l Corresponding author, Tel.: +I 313 3437798;Fax: +l 313 3434932.
was notable for a grade-II systolic ejection murmur at the left upper sternal border as well as a grade-II diastolic murmur at the right upper sternal border. The patient was started on an intravenous antibiotic regimen of clindamycin, gentamicin and vancomycin. An echocardiogram did not demonstrate any vegetations but did show severe aortic insufficiency and possible mitral regurgitation. On the 4th day of admission the patient developed congestive heart failure. She underwent cardiac catheterization which demonstrated normal pulmonary artery pressures, a severely elevated left ventricular end-diastolic pressure, mild-tomoderate systolic dysfunction with a dilated left ventricle, severe aortic regurgitation and normal coronary arteries. A transesophageal echocardiogram was performed showing vegetations on the aortic valve, destruction of the aortic valve and a cavity right beneath the aortic valve between the aortic valve and the anterior mitral leaflet. The patient underwent an aortic valve replacement with a no. 21 St Jude valve without complication. Findings at surgery included a large vegetation on the
0020-7292/96/$.15.000 1996 International Federation of Gynecology and Obstetrics PII: SOO20-7292(96)02687-2
114
G.D. Hautman, S.J. Sherman/International
Journal of Gynecology & Obstetrics 54 (1996) 173-174
left coronary cusp, severedamage to the cusp and a large cavity measuring 3 x 1.5 cm deep beneath the left coronary cusp and anterior leaflet of the mitral valve. She was discharged home on day 50 in good condition. Although bacterial endocarditis is an extremely rare diagnosis in pregnancy and puerperium it is important to keep it in the differential diagnosis when puerperal fever is present [ 1,2]. Rapid detection and appropriate treatment of this condition
will result in very low maternal and fetal morbidity and mortality. References 111 Payne DG, Fishbume JI, Rufty AJ, Johnson F. Bacterial
endocarditis in pregnancy. Obstet Gynecol 1982; 60: 247-250.
PI Seaworth BJ, Durack DT. Infective endocarditis in
obstetric and gynecologic practice. Am J Obstet Gynecol 1986; 154: 180-188.