Introduction
26 years old female patient known history of Down syndrome and eisenmenger syndrome was referred to our clinic fever, fatigue and new onset dyspnea and edema. Patient s vital signs on admission, blood pressure 100/70 mmhg, heart rate 120 bpm, respirator rate 21/minute and temperature 39,1 C0. ECG on admission showed sinus tachycardia with right ventricular strain pattern.
Method
Echocardiography revealed large ventricular septal defect with bidirectional flow pattern with severe mitral regurgitation. Moreover, large vegetation like mass revealed on defect area (Figure-1). Transesophageal echocardiography confirmed the vegetation. After the diagnose heart team decided medical treatment strategy due to high surgery risk. Vancomycin treatment was initiated. Two days after the treatment, patient developed new onset dyspnea and oxygen saturation decreased. Patient was intubated and attached to ventilator. However, she died persistent respiratory failure four days to admission
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