Isolated Leaflet Replacement in Tricuspid Valve Infective Endocarditis

Abstract

Objective: Right-sided infective endocarditis (IE) is less common than left, incorporating only 5-10% of cases. Ninety percent of right-sided IE affects the tricuspid valve (TV). Right-sided IE and TVIE are strongly associated with intravenous drug use (IVDU), although device implants also represent major risk factors. Patients undergoing surgical treatment for TVIE demonstrate acceptable early and late outcomes, valve repair is significantly protective against recurrent endocarditis. We present a 21-year-old IVDU, who suffered from isolated destruction of the TV anterior leaflet caused by colonisation of Staphylococcus aureus, and a successful leaflet repair was performed. Methods: Due to presence of vegetations over 20 mm resulting in recurrent pulmonary embolization, and sustained S. aureus bacteraemia despite appropriate antimicrobial treatment, surgery was indicated. On intraoperative inspection the anterior leaflet was exclusively infiltrated by the infective process without annular involvement; therefore, decision was made to replace it with a bovine pericardial patch and supportive neochords. To reduce application of more potentially infection prone implants, the requirement for annular stabilisation was undertaken with deVega annuloplasty. Results: After fourteen days of hospital stay the patient was discharged to a specialized rehabilitation centre and completed six weeks antibiotic course. Pre-discharge echocardiography revealed structural and functional tricuspid valve with only mild residual insufficiency. Conclusions: Albeit non-surgical treatment is preferred in majority of TVIE cases, if surgery is indicated, procedures can be performed at low operative mortality and excellent survival. Septic pulmonary embolism or failed medical therapy is the main reason to operate rather than severity of TV regurgitation itself. Early surgical intervention prevents further embolism and destruction of leaflet tissue; enhancing probability of TV repair. KEYWORD: e-PD-16 The authors do not declare any conflict of interest.