Background
It is well known that congenital heart disease, especially a ventricular septal defect, is associated with a high risk of infective endocarditis. There are few reports of infective endocarditis with vegetations extending from the right ventricle into the pulmonary artery, resulting in pulmonary artery embolism. It is also well known that atopic dermatitis can be associated with systemic infections such as infective carditis. Here, we report a patient with a ventricular septal defect and infective endocarditis caused by atopic dermatitis who presented with massively infected vegetations occluding the pulmonary artery and extending from the right ventricle into the pulmonary artery and was treated surgically.
Case presentation
A 26-year-old woman with a ventricular septal defect and a history of atopic dermatitis was diagnosed with infective endocarditis with mobile vegetations in the right ventricle, pulmonary artery occlusion caused by massive vegetations, and pulmonary abscesses. Because the obstructing vegetations did not regress with antibiotics, they were removed surgically and the ventricular septal defect was closed. A new causative organism was identified in the vegetation, enabling optimization of the antibiotic regimen. Appropriate antibiotics were administered for 2 months after surgery, resulting in complete resolution of the lung abscesses.
Conclusion
Aggressive surgical intervention can be effective in patients with massive vegetations obstructing their pulmonary arteries.
Previous study from our laboratory demonstrated that the renal sensory afferent fibers responded to NaCl concentration in the renal artery, i.e., the renal afferent nerve activity was increased by an intrarenal arterial infusion of hypertonic NaCl solution in a dose dependent manner. However, a physiological significance of the increased renal afferent nerve activity was still unclear. We hypothesized that the renal afferent nerves may contribute to body fluid homeostasis through controlling arginine vasopressin (AVP) release. To examine this, plasma AVP was measured, while intrarenal NaCl receptors were selectively stimulated by a small dose infusion of hypertonic NaCl in conscious rats. Under a gas anesthesia, a PE‐10 catheter for NaCl infusion was inserted into the right renal artery via the suprarenal artery and a PE‐50 catheter for blood sampling was inserted into the abdominal aorta via the left femoral artery; these catheters were exteriorized from the back of the neck and connected to a swivel. One day was elapsed to recover from anesthesia and the surgery. Hyperosmotic NaCl solution (616 mmol/L) was infused into the renal artery at a rate of 50 μL/min for 10 min. Plasma Na+ concentration was not affected by this infusion (from 142.8 ± 0.6 to 143.6 ± 0.4 mmol/L), while plasma K+ concentration was significantly decreased (4.3 ± 0.1 to 4.1 ± 0.1 mmol/L). The hypertonic NaCl infusion significantly increased plasma AVP concentration from 2.8 ± 0.2 to 3.4 ± 0.4 pg/mL. This response was completely abolished by renal denervation. These data indicate that the renal sensory afferent fibers might sense changes in the intrarenal arterial NaCl concentration and alter AVP release.
We herein report a case of cardiac tumor resection through a right mini-thoracotomy. A 48-year-old man exhibited no symptoms. A mass was detected incidentally in the right atrium on computed tomography. We performed resection under cardiopulmonary bypass through a right mini-thoracotomy. Histopathological examination confirmed that this tumor was a lipoma. The patient s postoperative recovery was uneventful. He was discharged on postoperative day 6. As cardiac tumor resection through right minithoracotomy is minimally invasive, this approach may be useful for surgery in cases of benign cardiac tumors.
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