A 29-Year-Old Man with Uncorrected Congenital Patent Ductus Arteriosus Presenting with Heart Failure and Pulmonary Artery Vegetations Removed During Surgery: A Case Report

BACKGROUND Infective endocarditis (IE) involving isolated vegetations in the pulmonary artery is an exceedingly rare clinical entity. The absence of standardized guidelines regarding management and timing of intervention further complicates treatment decisions. This report describes the case of a 29-year-old man with uncorrected congenital patent ductus arteriosus (PDA) presenting with heart failure and pulmonary artery vegetations removed during PDA surgical ligation. CASE REPORT A 29-year-old man with a history of undiagnosed, untreated congenital heart disease presented with worsening symptoms of heart failure. Initial management included diuretic and empirical antibiotic therapy. Echocardiography and cardiac computed tomography revealed a large type C PDA with an 8.9 mm diameter, with multiple mobile vegetations in the pulmonary artery. Inflammatory markers and infection indicators showed significant improvement within 48 hours. On day 3, the patient underwent surgical evacuation of the pulmonary artery vegetations and PDA ligation. The surgery was successful, and vegetation cultures were negative, confirming blood culture-negative infective endocarditis. Given the potential for other difficult-to-culture bacterial infections, antibiotics were continued until 10 days postoperatively. The patient was discharged on day 10 in stable condition. Follow-up echocardiography showed significant improvement with reverse remodelling. CONCLUSIONS This case underscores the importance of aggressive surgical intervention for the removal of pulmonary artery vegetations, irrespective of their size, in reducing the risk of acute pulmonary embolism. The approach was safe, and no significant post-procedure adverse outcomes were noted, offering valuable insights into the management of IE with PDA and pulmonary artery involvement.