PDA-associated infective endocarditis with pulmonary artery perforation

Infective endocarditis used to frequently cause mortality in subjects having PDA before the advent of antibiotics and surgical ligation. It has been documented that clinically silent PDAs may cause infective complications of heart valves. We present case of an 18-years-old male who presented with palpitations and fever to our emergency department. The fever was sudden in onset, associated with rigors, high-grade and with a continuous pattern for 12 days. The patient was previously managed as a case of dengue fever based on serology. Eight days after the onset of fever, the patient developed left-sided chest pain. Past medical record showed documentation of a patent ductus arteriosus. A two-dimensional echocardiography showed circumferential pericardial effusion and a small-sized PDA; the left ventricular function was normal. Nevertheless, the definitive cause of the pericardial effusion was not known. The patient became haemodynamically unstable during the hospital stay and it was planned to ligate the PDA with cardiac surgical consultation. A left thoracotomy approach was chosen for the PDA ligation that unveiled rupture of the main pulmonary artery, so the pulmonary artery repair alongside the PDA ligation was planned with median sternotomy approach and cardiopulmonary bypass immediately. The patient had a 14-days course of antibiotics during the ICU stay. In conclusion, infective endocarditis remains a rare yet life-threatening complication of PDA irrespective of the size; a timely PDA-ligation could prevent the life-threatening sequels.