Tricuspid valve endocarditis in non-drug abusers: A case series from India

Objective The etiology of tricuspid valve endocarditis (TVE) seems to be different in our country as intravenous (IV) drug abuse is not known to be a major health hazard. The objective of this communication is to study the risk factors, clinical profile, follow-up data of TVE patients and focus on the difficulties in diagnosis and variations encountered. Methods A retrospective analysis of data of 10 patients of TVE managed in a tertiary care center during January 1992 to June 2015 was done. Results TVE was encountered in a diverse subset of patients with cardiac implantable electronic device (CIED) (group I; 3 patients), immunocompromised state with indwelling central venous catheter (CVC) (group II; 2 patients), congenital heart disease (CHD) (group III; 3 patients) and in apparently healthy individuals (group IV; 2 patients). Blood cultures were negative in half the patients. In group I early surgical extraction of leads, device and vegetation provided excellent results. Prognosis was poor with 100% mortality in immunocompromised patients. Patients in group III did well on medical management. The overall mortality was high (30% in hospital and additional 20% within one year). Conclusions TVE is rare and can occur in different clinical scenarios. Indiscriminate use of antibiotics modifies the clinical picture causing delay in diagnosis and referral to speciality care. Echocardiography remains the main modality and should be used serially to facilitate early diagnosis. The prognosis is guarded. Early surgery is recommended in pacemaker lead, fungal endocarditis, persistent sepsis or hemodynamic instability for favorable prognosis.

Tricuspid Valve Replacement in an Adult with Destroyed Tricuspid Valve and Refractory Right Heart Failure.

22 year old woman with no previous heart disease history, presented with progressive worsening of right heart failure symptoms due to severe tricuspid valve regurgitation which had become refractory to medical management. Echocardiogram revealed probable rare case of dysplastic tricuspid valve with large calcified mobile masses attached to leaflets. Calcified masses were thought to be due to healed vegetations from silent infective endocarditis of abnormal tricuspid valve which she had suffered in the past. There were no known acquired causes of tricuspid valve endocarditis. She had successfully undergone tricuspid valve replacement with bio-prosthetic valve along with a right atrial reduction surgery after which her heart failure symptoms improved markedly.

Successful Repair of Tricuspid Valve Endocarditis in a Drug Abuser / 日本心臓血管外科学会雑誌

This case report describes a 20-year-old man, who was a drug abuser, and was treated surgically for tricuspid valve endocarditis. He presented with fever, caused by tricuspid valve endocarditis with a lung abscess. Blood culture detected <i>Staphylococcus aureus </i>and cardiac ultrasonography showed tricuspid insufficiency and tricuspid valve vegetation. He was treated with intravenous antibacterial agents, but the inflammation signs did not improve. He had a large number of puncture scars, as a consequence of self-injection of drugs in his lower arm. He underwent tricuspid valve plasty, and recovered successfully. He was discharged 2 weeks after surgery, and we instructed him to return for follow-up examination in our hospital. However, he did not return to our hospital because he was arrested for drug possession. In such cases, it is necessary to consider the operative method relative to reuse of drugs in the postoperative management of medication.

A Case of Valve Repair for Active Infective Endocarditis Located in the Tricuspid Valve / 日本心臓血管外科学会雑誌

We report surgically treated case of tricuspid valve endocarditis in a non-drug addict. A 35-year-old man with no history of cardiac disease was admitted to our institution for persistent fever. His blood culture was positive for methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA). Echocardiography showed friable vegetations attached to the tricuspid valve with moderate tricuspid regurgitation. No other valves were affected. Chest computed tomography revealed multiple septic pulmonary emboli in both lungs. The infection was uncontrollable, so despite 6 weeks' of appropriate intravenous antibiotics therapy, he required surgery. Infected lesions had extended to parts of the septal leaflet and the posterior leaflet of the tricuspid valve. Valve repair with the resection-suture technique was performed. Half of the septal leaflet and a part of the posterior leaflet were excised with the vegetations, and the remaining septal leaflet was sutured to the posterior leaflet after annular plication without implanting an artificial ring. The postoperative course was uneventful, without further tricuspid regurgitation or stenosis. He was discharged after additional antibiotic administration for 4 weeks postoperatively, and he has remained free from endocarditis for over 1 year.

A case of tricuspid valve infective endocarditis following Lemierre syndrome / 대한내과학회지

Lemierre syndrome is characterized by an acute oropharyngeal infection with septic thrombophlebitis of the internal jugular vein, anaerobic bacteremia, and multiple metastatic abscess, frequently involving lung. The most common etiologic organism is Fusobacterium necrophorum. In this case, otomastoiditis causes internal jugular vein thrombophlebitis, which complicates pulmonary septic embolism and tricuspid valve endocarditis. The patient had no underlying heart disease and wasn't injection drug user. Blood culture revealed Bacteroides fragilis group and group G beta-hemolytic Streptococcus. Pulmonary septic embolism is common complication in patient with Lemierre syndrome, but endocarditis is very rare, moreover tricuspid valve involvement. As widespread use of antibiotics, this syndrome becomes rare and typical course of the disease has changed. It leads to decrease recognition of this syndrome. But, Lemierre syndrome is potentially fatal if early diagnosis and appropriate antibiotic treatment is not followed.

A Case of Tricuspid Valve Endocarditis with Vegetation in a Non-Drug Addict without Underlying Cardiac Disease

Tricuspid valve endocarditis accounts for 5% to 10% of cases of infective endocarditis. It commonly occurs in intravenous drug abusers, intravenous catheters, alcoholism, immune deficiency and genital sepsis. But right sided infective endocarditis without predisposing factor is very rare. S. aureus is the usual pathogen. We experienced a case of tricuspid valve endocarditis in a 32 year old female with vegetation in a non drug addict without underlying cardiac disease. The vegetation on the septal cusp of tricuspid valve and tricuspid regurgitation were found by TTE & TEE. S. aureus was identified in 4 bottles of blood cultures. The diagnosis was delayed because the cardiac manifestations of the disease were subtle, and pleuropulmonary manifestations predominant. So we report a case of tricuspid valve endocarditis in a non drug addict without underlying cardiac disease with a review of literature.