Rupture of ventricular aneurysm due to infective endocarditis in a hemodialysis patient-a case report

The patient was a 44-year-old woman who had undergone maintenance hemodialysis since February 1985 due to chronic glomerulneritis. In Octorber 2002, she developed fever, general arthralgia, lumbago and rightsided gluteal pain. Laboratory test demonstrated severe inflammation and MSSA (methicifin sensitive Stapylococcus aureus) was isolated by blood culture. Echocardiogram disclosed calcification and vegetation on the posterior mitral leaflet. The patient was transferred to our hospital for further evaluation of infective endocarditis. Computed tomography showed systemic multiple abscesses. She underwent urgent surgery (mitral valve replacement) on October 23 because of worsening of left-sided heart failure, a large vegetation (1.5-2.0cm) and multiple embolic events. Thereafter, inflammatory data declined, but 9 days later, cardiac tamponade developed due to perforation of the right ventricle. The perforated portion was obliterated by mattress suture using pericardium. Thereafter, her general condition gradually improved. However, cardiac tamponade occurred again 51 days after the valve replacement therapy. Computed tomography demonstrated ruptured ventricular aneurysm under the prosthetic valve and she died on the same day. We report a rare case that developed an infected ventricular aneurysm during maintenance hemodialysis. If patients on long-term hemodialysis become complicated by cardiac valvular diseases due to metastatic calcification, we need to pay attention to the onset of infective endocarditis in these patients.