Infective Endarteritis and Massive Pulmonary Artery Aneurysm Formation in a Child with Untreated Large Patent Ductus Arteriosus: Case Report from Tanzania

Special Issue - Pediatric Cardiology

J Pediatr & Child Health Care. 2017; 2(1): 1015.

Infective Endarteritis and Massive Pulmonary Artery Aneurysm Formation in a Child with Untreated Large Patent Ductus Arteriosus: Case Report from Tanzania

Zuechner A1,2*, Kabyemera R1,2, Mhada T1,2, Majani N³, Warrier G4 and Freund MW5

¹Department of Pediatrics, Bugando Medical Centre, Tanzania

²Department of Pediatrics, Catholic University of Health and Allied Sciences, Tanzania

³JakayaKikwete Cardiac Institute, Tanzania

4Department of Cardiothoracic Surgery, Apollo Hospital Hyderabad, India

5Department of Paediatric Cardiology, Germany

*Corresponding author: Zuechner A, Department of Pediatrics, BugandoMedical Centre, Wurzburg Road, Mwanza, Tanzania

Received: May 04, 2017; Accepted: July 05, 2017; Published: July 11, 2017


Indication for Patent Ductus Arteriosus (PDA) closure is widely accepted for hemodynamic reasons only. However, patients with PDA are at risk for Infective Endarteritis (IE), which may cause serious complications and even lead to death. We report a case of infective endarteritis with the rare complication of a massive pulmonary artery aneurysm formation in a child with an undiagnosed large PDA.

A seven-year-old girl was referred to a tertiary referral hospital in Tanzania with two weeks of fever, difficult breathing and general body weakness. Furthermore, she complained of long-standing fatigability. Prior to referral, an oral antibiotic treatment was started elsewhere.

On examination the girl was ill-looking with left sided chest bulging, precordial hyperactivity and a grade IV continuous systolic-diastolic murmur at the left upper sternal border with palpable thrill.

Two-dimensional echocardiography revealed a large PDA with turbulent left to right shunt. Furthermore, a large vegetation in the distal main pulmonary artery and a small aneurysm were detected. Follow-up echocardiography over the course of six weeks revealed an increasing aneurysm of the Pulmonary Artery (PA), finally covering a large part of the left chest. Antibiotic treatment was started and five months after the onset of the IE a successful surgical resection of the PA-aneurysm formation and PDA-closure was performed with full clinical recovery.

In conclusion, patients with relevant PDA are at risk developing IE and other serious complications. We therefore recommend that a significant PDA should not only be closed for hemodynamic reasons, but also to prevent life-threatening endarteritis.

Keywords: Patent Ductus Arteriosus (PDA); Infective endarteritis; Vegetation; Pulmonary artery aneurysm


Patent Ductus Arteriosus (PDA), among other congenital and acquired heart diseases, increases the risk of infective endarteritis [1]. Before the introduction of antibiotic therapy and surgical closure, infective end arteritis was a possible cause of death in patients with PDA [2]. However, currently, indication for PDA closure is accepted mainly for hemodynamic reasons [3,4].

Case Report

A seven-year-old girl was presented to Bugando Medical Centre (BMC) in Mwanza, North Western Tanzania, with fever, difficult breathing and general body weakness for two weeks. Furthermore, for three years she complained about fatigability. Before admission to BMC the girl was treated in a district hospital for the diagnosis of rheumatic heart disease and received penicillin.

On examination the girl was weak and ill-looking with a temperature of 38.50C, respiratory rate of 52 breaths/minute and pulse rate of 138 beats/min. The oxygen saturation was 96% in room air. Her weight was 22 kg and height was 125 cm, equivalent to the body mass index of 14.1. Left sided chest bulging, precordial hyperactivity and raised jugular venous pressure were observed. The apex beat was palpated at seventh inter-costal space and a grade IV continuous systolic-diastolic murmur with palpable thrill was auscultated at the left upper sternal border.

Two-dimensional echocardiography revealed dilated left atrium and left ventricle (LVID 58/36 mm, Z-score LVIDd+4.0 and LVIDs+3.2 [5], hyperdynamic contractility (SF 39%), a large PDA with a floating vegetation in the distal main and proximal left pulmonary artery and a wall defect of the pulmonary artery resulting in an aneurysm formation (Figure1 and 2).The chest X-ray showed severe cardiomegaly with enlarged pulmonary arteries (Figure 4). The diagnosis of large PDA with infective endarteritis and formation of a pulmonary artery aneurysm was made. Intravenous antibiotic therapy (X-penicillin and gentamycin) was initiated after blood cultures were taken. Furthermore, anti-congestive therapy with furosemide (1mg/ kg 8 hourly), captopril (0.5 mg/kg 8 hourly) and digoxin was started accompanied by high caloric feeding. Serial echocardiography studies, in the following six weeks, showed a continuous increase in the size of the aneurysm formation. The defect in the pulmonary artery wall, being the entrance to the aneurysm, additionally increased in size, measuring two cm (Figure 2 and 3). Finally, the aneurysm nearly occupied the entire left hemi-thorax (Figure 4a).