Late endocarditis complicating patch repair of post-infarction ventricular septal defect

Post-infarction ventricular septal defects (PIVSD) complicate about 1%- 2% of all acute transmural myocardial infarcts.¹ Surgical closure remains the only definitive treatment, and survival ranges from 80%-90%. No general recommendations exist for postoperative antibiotic prophylaxis in such patients who typically have a Dacron patch placed to repair the defect. In contrast, prophylaxis is recommended for infants following repair of congenital ventricular septal defect (VSD) while the patch is incompletely endothelialized.² We present a case of late postoperative endocarditis presenting 4 years following repair of a PIVSD with a low porosity Dacron patch. Lack of endothelialization of the patch may have contributed to this infectious complication. Antibiotic prophylaxis for PIVSD patches is discussed.