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.

Role of Echocardiographic Imaging in Percutaneous Balloon Mitral Valvotomy.

Mitral stenosis (MS) is a still frequently encountered in India and Bangladesh. Untreated MS contributes to the morbidity and mortality. Balloon mitral Valvotomy is effective and commonly used for relief of obstruction in symptomatic patients. The case selection is guided by clinical characteristics and imaging. Echocardiography is the most important imaging modality to assess severity of obstruction its hemodynamic consequences as well as valve morphology. Transthoracic two dimensional echocardiography is usually sufficient to provide the desired information. Trans esophageal echocardiography is used when the valve cannot be adequately assessed by trans thoracic echocardiography and to exclude intracardiac thrombi prior to intervention. Three dimensional transthoracic and trans esophageal echocardiographic assessment provides more elaborate physiological and morphological information.