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