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Ann Thorac Surg 2008;85:1458. doi:10.1016/j.athoracsur.2007.01.037
© 2008 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Contained Perforation of the Left Ventricle Due to Infective Endocarditis

Can Yerebakan, MD*, Semih Buz, MD, Roland Hetzer, MD, PhD

Department of Thoracic and Cardiovascular Surgery, German Heart Institute Berlin, Berlin, Germany

* Address correspondence to Dr Yerebakan, Department of Cardiac Surgery, University of Rostock, Schillingallee 35, Rostock, 18057, Germany (Email: can.yerebakan{at}med.uni-rostock.de).

A 49-year-old man was admitted with endocarditis of the aortic valve after septic shock caused by methicillin-resistant Staphylococcus aureus 2 weeks before. The patient was known to have double-vessel coronary artery disease and ischemic cardiomyopathy. Two coronary artery bypass procedures had been performed in the years 1986 and 2002.

A paracardial compressive formation in the left hemithorax was seen in the chest roentgenogram. Unfortunately, signs in an echocardiography of contained perforation on the anteroseptal left ventricular wall were strongly doubted. A computed tomography scan of the thorax confirmed this finding, however, showing contrast medium flow through two perforations in the anteroseptal region of the left ventricle. One was located near the left ventricular outflow tract, and the other was in the middle anteroseptal region. Figure 1 (A and B) is a three-dimensional reconstruction of the heart showing two sides of the contrast medium leaks (arrows 1 and 2) of the left ventricle, calcifications near the apical region (arrow 3), and a hematoma formation (arrow 4).


Figure 1
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  		Fig 1.
 
Myocardial septic abscess formation is reported [1, 2], but survival after perforation of the left ventricular wall, as in this patient, is very uncommon [2, 3]. To our knowledge, this report represents the second case in the literature of a patient who survived a perforation of the left ventricle due to myocardial abscess after infective endocarditis.


   Acknowledgments
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I thank Anne Gale for editorial assistance.


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  1. Aslam M, Sandhu MY, Schweitzer P, Herschkowitz M. Myocardial abscess: clinical and pathological findings in twenty patients J Med Soc N J 1979;76:833-837.[Medline]
  2. Gladden JR. Myocardial abscess with perforation of the heart following staphylococcal pyemia Clin Orthop Relat Res 1999;362:6-11.[Medline]
  3. Shackcloth MJ, Dihmis WC. Contained rupture of a myocardial abscess in the free wall of the left ventricle Ann Thorac Surg 2001;72:617-619.[Abstract/Free Full Text]




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