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A case of infectious endocarditis associated with Laubry-Pezzi syndrome

Session Poster Session 4

Speaker Hao Thai Phan

Event : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease – Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : TH Phan (Ho Chi Minh,VN)

Authors:
TH Phan1 , 1Pham Ngoc Thach University of Medicine - Ho Chi Minh City - Viet Nam ,

Citation:

Introduction:

Charles Laubry and Cesare Pezzi described the clinical features of Laubry-Pezzi syndrome in 1921 in a patient with ventricular septal defect (VSD) with aortic regurgitation caused by aortic valve prolapse. The syndrome may eventually lead to dilatation of the aortic sinus related to the involved leaflet, resulting from a lack of continuity of the aortic media and annulus. Laubry and Pezzi syndrome is a rare but serious complication of ventricular septal defect that increase the infectious endocarditis risk. We reported a case of infectious endocarditis associated with Laubry-Pezzi syndrome.

Case Report:

A 29-year-old Vietnamese, nonsmoker, nonalcoholic, non-diabetic, normotensive man from a province presented with dyspnea on lying, two-week fever. In the physical examination, edema in both lower limbs. Crepitant rales in both lungs. Apex beat shifted outwardly and below the 5th intercostal space, in the anterior axillary line. A 3/4 grade diastolic murmur at at third left intercostal space and an holosystolic murmur of a 4/6 degree at the fourth-sixth left intercostal space level, with radiation to the right lower sternal border. Heart rate: 113 bpm. Blood pressure: 130/60 mmHg. spO2 :98% (air room).

Results:

Electrocardiogarphy showed sinus tachycardia with left ventricular enlargement. Chest X-ray: cardiac shadow was large, redistribution of pulmonary blood flow. Echocardiography: left-right shunt subaortic VSD (8mm), severe aortic valve regurgitation, prolapsing of the right coronary, a ruptured abcess with diameter 12x11mm in right coronary cusp, left ventricular EF: 63%, PASP: 45mmHg. Cardiac MSCT: subaortic VSD 10mm, a ruptured abcess with diameter 12x11mm in right coronary cusp. Sinus valsalva dilation diameter # 45mm. Normal coronary arteries. Infectious endocarditis associated with Laubry-Pezzi syndrome was diagnosed. After 28 days of antibiotic of infectious endocarditis, surgical procedure modified Bentall was performed and the ventricular septal defect was closed with a Dacron patch. After operation patient’s postoperative course was uneventful with improvement of heart function.

Discussion:

The Laubry-Pezzi syndrome is a rare congenital hearth disease . It was reported for the first time by Laubry & Pezzi in 1921, its prevalence is 0.013 to 0.3%. Nearly always diagnosed in children and teenagers, since it is a congenital disease. In this congenital heart diaseases surgical indication, appropriate timing of surgery and operative technique are still matter of debate owing to its rare incidence among overall population.

Conclusion The Laubry-Pezzi syndrome is rare congenital heart disease leading to a significant alteration of cardiac hemodynamic. Bacterial endocarditis combined with Laubry-Pezzi syndrome have a poor prognosis needing observation and strict preventive precautions when a favoring factor is present. The surgical treatment is necessary and must be performed as soon as possible.

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