Bacterial endocarditis of the tricuspid valve in a 17 year old girl without congenital heart disease or preexisting risk factors

Abstract

Background. Infective endocarditis of the tricuspid valve is rare, occuring usually either in patients with congenital heart disease or with risk factors such as central lines, intravenous drug abuse or transvenous pacemaker leads. Since the symptoms of tricuspid valve endocarditis are unspecific, the diagnosis is often delayed. Case report. We present the case of tricuspid valve endocarditis occuring in a 17 years old girl without any risk faktors.The patient presented initially with unspecific symptomslike malaise, weightloss and intermittend fever as well as with a pleuropneumonia.The diagnosis was established by positive blood cultures (staphylococcus aureus) and echocardiographic identification of vegetations. Unequivocal demonstration of these alterations however required transesophageal echocardiography. Even though the vegetations were quite large and had destructed the posterior tricuspid leaflet, it was possible to reconstruct the valve with the remaining two leaflets. Conclusions. Children with severe pneumonia and a positive blood culture for staphylococcus aureus should always be evaluated for tricuspid valve endocarditis. If echocardiography reveals suspicious findings transesophageal echocardiography should be performed immediately.