LeVeen Shunt Endocarditis

To the Editor.  —In the September Archives Valla et al¹ noted that bacterial endocarditis complicating peritoneovenous shunt (PVS) carries high mortality and suggested that echocardiography should be useful in diagnosis. We describe a patient in whom successful treatment of PVS-associated endocarditis was predicated on early diagnosis using two-dimensional echocardiography.

Report of a Case.  —A 42-year-old man with chronic alcoholism underwent PVS (LeVeen) shunt insertion for intractable ascites. His initial clinical course was reported previously.² Fifteen months later, a progressively enlarging umbilical hernia was repaired. Four months thereafter, a persistently indurated, reddened area at the herniorrhaphy site was opened, uncovering a smoldering Staphylococcus aureus wound infection. Despite drainage and therapy with oral antibiotics, an intermittent fever developed, and a chest roentgenogram disclosed bilateral pulmonary infiltrates consistent with a diagnosis of septic emboli. Staphylococcus aureus was cultured from both sputum and blood. The PVS was removed and found to be