Abstract
Aim: To report a case of right ventricular myxoma prolapsing through the tricuspid valve with an attachment of vegetation in a 3-year-old male child. Introduction: Right-sided endocarditis commonly involves the tricuspid valve. Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis. RV (right ventricular) myxoma harboured the infection due to trauma as a result of friction movement across the tricuspid valve. Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma. The vegetation was found to be attached with the tumor and it disappeared with antibiotics and aspirin therapy and the child was advised surgical removal of the tumor. Conclusion: A diagnosis of infective endocarditis can be made in tricuspid valve dysfunction with a floating mass and fever. The cardiac myxoma with an attached vegetation is masquerading as vegetation mass on transthoracic echocardiography in this child.
Highlights
Infective endocarditis (IE) is a microbial infection of the endocardial surface of the heart
Low pressure and low oxygen saturation in the right sided cardiac chambers protect the tricuspid and pulmonary valves from being subjected to excessive strained and damage occurs from injected particulate matter, contaminated venous lines and drug solutions causing endocarditis
Case Report: A 3-year-old male child having the spikes of fever for 2 weeks, presented with tumor “plop” and 3/6 systolic murmur in lower left sternal border and echocardiography revealed a tumor-mimicking vegetation visible as a mass lesion across the tricuspid valve, which is attached to the interventricular septum by a pedicle suggesting a RV myxoma
Summary
Infective endocarditis (IE) is a microbial infection of the endocardial (endothelial) surface of the heart. It accounts for about 0.75 admissions per 1000 per year in large community hospitals [1] and a population based incidence of 4 - 10 per 100,000 per year, with a slightly higher rate in men [2] [3]. Children with underlying cardiovascular disease may develop endocarditis at any age. It is most frequent on the left side of the heart [4]. Right-sided infective endocarditis is relatively rare and occurring in 5% - 10% of cases [5]. The majority of cases of neonatal infective endocarditis are right-sided and occur on structurally normal hearts [7], probably due to increased use of prosthetic intravascular devices and indwelling venous catheters [8]
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