Re: Complicated Subacute Bacterial Endocarditis in a Patient with Ventricular Septal Defect

Sir, I have two comments on the interesting case report published in the February 2014 issue of the Sultan Qaboos University Medical Journal (SQUMJ) by Al-Senaidi et al.1 First, echocardiography (ECHO) is included in the diagnostic algorithm of infective endocarditis (IE). In their case report, Al-Senaidi et al. noted that the ECHO showed a 4 mm perimembranous ventricular septal defect with a leftto- right shunt and a peak gradient of 85 mmHg. There were also two vegetations attached to the tricuspid valve with moderate regurgitation and no stenosis. The large vegetation measured 8 x 6 mm and the smaller one, 6 x 4 mm. During the patient’s clinical course, the large vegetation was dislodged and caused a pulmonary embolism.