Delayed diagnosis of congenital cardiopathy (CGC)

Introduction: Generally, CGC are detected in the fetal or neonatal period, but recent studies showed an im-portant proportion of their late diagnosis. At adults, the associated complications are the diagnosis context of CGC. Aortic coarctation (ACO) is a common CGC, representing 5-8% of all congenital diseases, and it is associated in 50-85% of cases with bicuspid aortic valve (BAV). This association increases the risk of complications, especially of infectious endocarditis (IE) and heart failure (HF).
Case presentation: We present the case of a 28 years old patient diagnosed with IE with Enterococcus on aortic and mitral valve in a territorial hospital, treated 14 days with antibiotics, transferred to the Cardiovas-cular Disease Institute from Iași because of the worse-ning of the HF. Upon admission, the patient was afe-bril, hemodynamically stable, tachycardic, BP=150/80 mmHg. The cardiovascular examination discovered a pluriorificial systolo-diastolic murmur, weak bilateral femoral pulse, signs of cardiac and pulmonary con-gestion; O2 saturation in atmospheric air=92%. Biologically, there was found inflammatory syndrome with neutrophilia and anemia.
Electrocardiography: sinus rhythm, 103/min, left ventricular hypertrophy (LVH). Chest radiography: cardiomegaly, hills pulmonary infiltration, right costo-phrenic sinus opaque, erosions of the lower ribs. Tran-sthoracic echocardiography: dilated left ventricular cavitations, LVH, hyperkinetic contractions, spontane-ous contrast in left ventricle, BAV, vegetation attached to the anterior aortic cusp, perforation at the base of the posterior aortic cusp, causing severe aortic regur-gitation (PHT=148 msec), broken abcess on the an-terior mitral valve (MV), perforation of the posterior MV causing severe mitral regurgitation, EF=53%, ACO through a hyperecogenic diaphragm, located after the emergence of the subclavicular artery. In this context, antibiotic, beta-blocker and diuretic treatment was continued, oxygen therapy, digital therapy and intrave-nous nitroglycerin were initiated. Due to the refractory HF, on the 6th day of hospitalization he is transferred to the cardiovascular surgery clinic where aortic and mitral valves were replaced with mechanical prothesis and the restoration of the aortic mitral curve was per-formed. The patient was having a favorable postopera-tive evolution.
Conclusions: Detecting a CGC by clinical or echocar-diographic screening in the early childhood is very im-portant to be able to plan the appropriate prophylaxis and subsequent therapeutic actions before the appea-rance of complications that associate an increased mor-bimortality risk.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)