I think that probably there are other cause for pulmonary absces if Infective Endocardites was excluded. Drug addiction increase the chances, specialy if his general clinical status is bad. Surgical closure of VSD is not the solution.

Dear José Jacob,

thank you for the answer. drug addiction may cause such complication. but it's not the context. general state is now better with no immunodeficiency.

we don't have any explication of the multiple bilateral pulmonary absces!!

Dear Mouchine. The diagnosis will be not easy. Do you perform primary pulmonary disease investigation? Mutation of gene of Mucoviscidosis or Cystic Fibrosis allows that the disease arise in adult life without pancreatic complications, but mainly pulmonar complication. Pulmonary infecton can be cause of pulmonary abscess.

Dear Mouchine. I disagree with Dr Spirad. If microthromri formation occur (I don1t know if tthis is true), I think that is not the cause of pumonary abscess.

Dr Sripad and Dr José, thanks for the interest you give to my question.

the patient was assessed by cardiologists , pneumologists and radiologists.

exhaustive explorations were done: biomarkers of infection, TTE, TOE, CT scann, MRI.

as a cardiac surgeon, seriously, i think there is no interest to close the restrictive VSD for many reasons:

the link betwenn VSD and pulmonary abcesses is not clear.

even if, surgical closure of vsd will not improve outcomes more than prevention and treatment of infective endocarditis specially and infections generally.

If there isn't IE, as in this case,I disagree that VSD closure is necessary, In this case IE is not present!!!

Actually, I think that a restrictive VSD almost never (never?) requires surgical closure.

If, as you wrote, the infection has been controlled by antibiotics I would continue the cardiologic follow-up of the patient by monitoring the LA/Ao ratio by echo twice or three times in the next year/18 months. Afterward I think you should have enough info for a final decision.

Take care

Claudio

thanks a lot for your answer Dear Claudio.

i think so, and opted for a cardiologic follow up me too.

Once the endocarditis is controlled, a device could be inserted.

I disagree of Dr. Menon. There is not evidence of endocarditis! In the question is write that there is not evidence of Endocarditis.

i also go with Dr Claudio's decision for this patient

There isn't any indication for surgery is this case and not is indicated percutaneous closure with some device!

I agree with cardiologist follow up. I would regard device closure almost contraindicated due to uncertain infection.