Abstract
Tricuspid valve endocarditis with recurrent septic pulmonary emboli is an indication for surgery. In this report, we present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU). The patient was admitted with multiple chief complaints of fatigue, chills, fever, cough, chest pain, and shortness of breath. She was found to have a large 1.8 cm (W) x 2.4 cm (L) mobile tricuspid valve vegetation on transthoracic echocardiogram (TTE). Despite being on appropriate antibiotics, the patient failed to improve clinically. Cardiothoracic surgery (CTS) evaluated the patient for surgical management of infective endocarditis (IE) given the size of vegetation, persistent bacteremia, and clinical deterioration. However, the risk/benefit ratio for open-heart surgery was high, given the history of active IVDU and hemodynamic instability. The patient underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and her condition significantly improved clinically afterward. We discuss the importance of suction filtration and veno-venous bypass in managing tricuspid valve endocarditis as an alternative in patients who are not ideal candidates for surgery and the need for more evidence regarding its effectiveness compared to surgery.
Highlights
Right-sided infective endocarditis (RSIE) is frequently associated with intravenous drug use (IVDU) [1]
We present a case of right-sided infective endocarditis (RSIE) in a female patient with a history of intravenous drug use (IVDU)
In patients with RSIE, surgery is indicated by large-size vegetations, if blood cultures remain positive despite being on appropriate antibiotics, or in cases of recurrent septic pulmonary embolism [6]
Summary
Right-sided infective endocarditis (RSIE) is frequently associated with intravenous drug use (IVDU) [1]. In patients with RSIE, surgery is indicated by large-size vegetations (defined as >2 cm for the right side), if blood cultures remain positive despite being on appropriate antibiotics, or in cases of recurrent septic pulmonary embolism [6]. We discuss the case of a patient with native tricuspid valve endocarditis with multiple septic pulmonary emboli, who underwent percutaneous extraction of the vegetation using suction filtration and veno-venous bypass and clinically improved afterward. The patient underwent percutaneous extraction of the tricuspid valve vegetation using suction filtration and veno-venous bypass. TEE showed moderate to severe tricuspid valve regurgitation and a 2.4 x 1.2 cm vegetation attached to the atrial side of the anterior tricuspid valve leaflet (Figure 2). The patient became hemodynamically stable the day after the procedure, and she was not febrile anymore She was transferred to the medical unit.
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