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.