engleski

An unexpected cause of right ventricular failure - an intruder in the right ventricular outflow tract

56-year-old male patient was admitted due to fever of unknown origin. Upon admission, the patient was in bad general condition with high values of inflammatory markers in laboratory results and signs og right side heart failure. Transthoracic (TTE) and transoesophageal (TEE) echocardiography described a visible hyperechogenic formation in a right ventricular outflow tract (RVOT), oriented towards pulmonic valve, 1.6 cm long and 0.3 cm wide. The patient initially refused the surgical procedure of foreign body extraction, until the clinical condition deteriorated. He was hospitalized again with fever, haemoculture positive on Escherichia coli. TTE now showed a formation of 8 mm, possibly vegetation on the ventricular surface of the PV with severe pulmonary insufficiency, severe tricuspid regurgitation and moderate right-side heart failure. MSCT of thorax identified a strange metal body, resembling to sewing needle in the RV area. The patient successfully operated, the bioprosthetic PV was implanted combined with TV repair and the foreign body was removed from the RV. Postoperative recovery went well. Foreign body was a sewing needle, but the patient could not remember how did it get there. Isolated right ventricular heart failure can be caused by PV insufficiency, as in our case by foreign body in RVOT finally complicated by endocarditis of pulmonary valve.

right ventricular heart failure ; foreign body ; pulmonary valve insufficiency

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