POST-INFARCTION INTERVENTRICULAR COMMUNICATION ASSOCIATED WITH APICAL ANEURYSM AND TRICUSPID ENDOCARDITIS IN A PATIENT WITH VERY HIGH SURGICAL RISK: A CASE REPORT

Abstract

This article aimed to report a rare clinical case of coexistence of post-infarction ventricular septal defect (VSD), left ventricular aneurysm, and tricuspid infective endocarditis, discussing the challenges of therapeutic management in a scenario of prohibitive surgical risk. This is a descriptive case report study, prepared according to the CARE Checklist guidelines. Data were obtained through medical record analysis, imaging exams, and literature review in the PubMed and LILACS databases. Ethical precepts and data anonymization were respected, according to Resolution 466/12. The case of a 51-year-old female patient with a previous myocardial infarction, admitted for decompensated heart failure and mixed shock after a complication of a pleural procedure (hemothorax), was analyzed. Echocardiographic investigation revealed the triad: apical aneurysm of the left ventricle, apical muscular VSD, and vegetation on the tricuspid valve associated with fungemia and bacteremia. Given the hemodynamic and infectious instability, and the prohibitive EuroSCORE, a timed conservative strategy with antibiotic therapy and intensive support was chosen. The association of ischemic mechanical complications and infective endocarditis presents a complex therapeutic dilemma. Conservative management, although reserved for selected cases, may be the only viable option in the face of unacceptable surgical risk, requiring rigorous multidisciplinary monitoring.