[Lead-related infective endocarditis with massive vegetation causing severe functionnal tricuspid stenosis]. / Sténose tricuspide fonctionnelle sévère occasionnée par une importante végétation suite à une endocardite sur sonde de pacemaker.

Lead-related infective endocarditis with negative hemocultures constitutes a severe condition potentially associated with a pejorative prognosis. It may induce a functional tricuspid stenosis caused by an important obstructive vegetation. We report the case of an 82 year-old woman in whom the lead-related endocarditis produced massive vegetation causing a severe functional tricuspid stenosis. We describe the medical history, diagnosis and treatment.

Surgical treatment of tricuspid valve endocarditis: a single-centre experience.

OBJECTIVES: We describe our ten-year experience with surgery for isolated tricuspid valve (TV) infective endocarditis. METHODS: Data were collected through a retrospective patient record review. Between 1999 and 2009, 13 (4.6%) patients had isolated TV surgery. The mean age was 40+/-15 years and there were nine male patients and 4 female patients. Eight (61%) patients were previous intravenous drug users. Indications for surgery included severe TV regurgitation (n=5), uncontrolled infection (n=4), septic pulmonary emboli (n=3) and TV stenosis (n=1). Staphylococcus aureus (n=3) and gram negative organisms (n=2) were isolated pre-operatively. Eleven patients had replacement surgery while two valves were repaired. RESULTS: There were no hospital deaths. Post-operative complications included new atrial fibrillation (n=5), re-operation (n=2), permanent pacemaker (n=2), and renal dialysis (n=1). Five (38%) patients died during the follow-up period. Cause of death was cardiac related in four patients. Actuarial survival was 63.1% at 3 years and 50.4% at 5 years. One patient developed recurrent TV endocarditis. There were no further cases of prosthetic valve failure. TV regurgitation remained trivial in both repaired valves. CONCLUSIONS: Surgery for isolated TV endocarditis is often associated with previous intravenous drug use. The procedure can be performed with acceptable hospital morbidity and no mortality. Late mortality is high, despite the young age of the patients.