Case Of Tricuspid Valve Endocarditis Research Articles

Cure of Polymicrobial Mycobacterium Abscessus and Chelonae Endocarditis Through Integrated Medical and Addiction Treatment

We present here a case of tricuspid valve endocarditis in a person who injects drugs (PWID) with Mycobacterium chelonae and Mycobacterium abscessus successfully treated with a combined medical and surgical approach. This case highlights multiple challenges faced in the cases of treating injection drug use endocarditis including delays in identification and diagnosis of mycobacterial organisms, concern for intravenous line manipulation, poly microbial endocarditis which can be difficult to detect, and need for patients to be admitted for prolonged periods. A systematic literature review of M. abscessus endocarditis is provided with parallels and teaching points between our case and the 14 additional reported cases identified, particularly our approach to addiction treatment in order to facilitate cure in this patient.

596. Distinct, Segregated Daptomycin-Susceptible and Daptomycin-Nonsusceptible Staphylococcus aureus Populations Associated with Tricuspid-Valve Infective Endocarditis

BackgroundLoss of daptomycin susceptibility in Staphylococcus aureus is often associated with sequestered foci of infection, driven by selection pressure from both administered antibiotics and host defense peptides. Susceptibility testing of the organism cultured from blood is assumed to parallel that of the infectious foci, such as heart valves. We studied a case of tricuspid valve endocarditis where one leaflet yielded exclusively daptomycin-nonsusceptible S. aureus and another leaflet yielded purely daptomycin-susceptible S. aureus. We examined the responses of the two populations to different anti-staphylococcal therapies to identify regimens effective against both isolates.MethodsBoth isolates were whole-genome-sequenced using Illumina technologies. The presence of heterogeneous daptomycin-resistant subpopulations was assessed by dilution plating and population analysis profiling. One compartment pharmacokinetic/pharmacodynamic modeling was used to simulate different potential antistaphylococcal pharmacotherapies against each isolate. Hemolysin activity was evaluated as a surrogate for accessory gene regulator function.ResultsThe daptomycin-susceptible isolate did not demonstrate heteroresistance while the daptomycin-resistant population was uniformly daptomycin nonsusceptible. The daptomycin non-susceptible isolate demonstrated regrowth by 72 hours of simulated treatment with vancomycin (2 g Q12H) or daptomycin (10 mg/kg daily). Adding cefazolin (2 g Q8H) to vancomycin or daptomycin prevented regrowth at 72 hours. The daptomycin-resistant isolate was deficient in hemolysin production suggesting agr dysfunction. Comparative sequencing identified daptomycin-resistant isolate mutations in mprF, purR and agrA.ConclusionThis case underscores the complex dynamics of the emergence of S. aureus resistance to daptomycin in vivo. Our pharmacokinetic modeling supports combination therapy in the treatment of endovascular MRSA infection. Reduced hemolytic activity supports the hypothesis that agr modulation is associated with persistent infection and/or treatment failure. Ongoing studies will identify features of distinct bacterial populations that promote ecological succession during infection at a sequestered anatomical site.Disclosures All authors: No reported disclosures.

Association of tuberculosis and tricuspid valve endocarditis in AIDS patient with Ebstein heart anomaly.

A case of tricuspid valve endocarditis in an AIDS patient, an intravenous drug user, initially empirically unsuccessfully treated as a Staphylococcus aureus infection, and thereafter turned to be, most likely, of Mycobacterium tuberculosis etiology is presented.

Eustachian valve endocarditis: Case report and literature review.

In the intravenous drug user (IVDU) population, infected right-sided valvular lesions are common, and this has been well described in the literature. The Eustachian valve (also known as the valve of the inferior vena cava) is another valve in close proximity to the tricuspid valve, which can, in rare cases, be the focus of infection. Eustachian valve endocarditis may be an under-recognised complication of Staphylococcus bacteraemia in IVDU population, often only identified by transesophageal imaging. We present a case of tricuspid valve endocarditis in an IVDU with secondary seeding on the Eustachian valve, and an accompanying literature review on this rare topic.

Isolated native tricuspid valve endocarditis due to group A β-hemolytic Streptococcus without drug addiction

We discuss a case of tricuspid valve endocarditis to group A Streptococcus in a middle-age man without a history of intravenous drug use.

重篤な肺膿瘍を合併した三尖弁位感染性心内膜炎の1治験例

症例は25歳の女性．幼少期よりアトピー性皮膚炎の既往がある．呼吸困難感，発熱，咳嗽，血痰を主訴に近医を受診した．胸部レントゲン検査では両側肺にまだら状の浸潤影を認め，肺炎の診断で抗菌薬による加療を開始された．しかし，抗菌薬の効果が乏しく，心エコーにて三尖弁に疣贅の付着を認め，感染性心内膜炎の診断で当科紹介となった．重篤な肺膿瘍を合併していたため，十分な抗菌薬加療が必要と判断し保存的加療を選択した．適切な抗菌薬にて症状および肺膿瘍は改善を得たが，弁破壊による三尖弁閉鎖不全の増悪と右心不全を認めたため，疣腫摘出および三尖弁形成術を行った．術後は呼吸器合併症の出現なく経過し，術前と合わせ6週間の抗菌薬加療を行い，術後19日目に独歩退院となった．今回，われわれは重篤な肺膿瘍を合併した三尖弁位感染性心内膜炎に対し，保存的加療を先行した後に待機的に手術を行うことで良好な術後経過を得ることができた1例を経験したので報告する．

卵円孔開存により疣腫塞栓を生じた三尖弁位感染性心内膜炎の1例

卵円孔開存を伴う三尖弁位感染性心内膜炎で，疣腫散布により多発梗塞，多発膿瘍を合併した症例を経験した．症例は28歳，女性．熱発および全身の関節痛を主訴に救急外来を受診した．CT，MRI検査にて脳梗塞，多発肺膿瘍，化膿性脊椎炎，腓腹筋膿瘍を認めた．心エコー検査では三尖弁に25 mm大の疣腫の付着と同弁の逆流を認め，感染性心内膜炎と診断され，同時に卵円孔開存の存在が判明した．血液培養ではメチシリン感受性ブドウ球菌（MSSA）が確認された．約5週間の抗生剤による保存的加療を行った後，疣腫除去術，Kay法による三尖弁形成術および卵円孔閉鎖術を施行した．術後は7週間の抗生剤投与を施行し，軽快退院となった．以後，感染性心内膜炎，多発梗塞の再燃を認めていない．三尖弁位感染性心内膜炎において，疣腫散布による左心系への合併症を併発した場合，卵円孔開存の存在を念頭に置くとともに，適切に手術時期を判断し対処することが肝要である．

A case of tricuspid valve endocarditis which was found out because of endogenous endopthalmitis

A case of tricuspid valve endocarditis which was found out because of endogenous endopthalmitis

Tricuspid valve endocarditis with septic pulmonary embolism following induced abortion in an immunocompetent patient: A case report

Infective endocarditis (IE) is a life-threatening disease where infections most commonly involve heart valves but may occur at the site of a septal defect or chordate tendinea or on the mural endocardium. Infection of arteriovenous shunts, arterioarterial shunts (patent ductus arteriosus), or coarctation of the infective aorta are clinically and pathologically similar to IE. Conditions predisposing to native valve endocarditis are rheumatic heart disease (where the mitral valve is frequently involved followed by the aortic valve), congenital heart disease (commonly patent ductus arteriosus, ventricular septal defect, and bicuspid aortic valve), and intravenous (IV) drug abusers [tricuspid valve (TV) commonly involved followed by the mitral valve and the aortic valve]. We report a case of TV endocarditis in a 25-year-old female patient after induced abortion at 16 weeks of pregnancy presented with pyrexia of unknown origin (PUO) and septic pulmonary embolism. The patient presented with fever with chills and rigors 2 weeks after the induced abortion. She remained febrile for 1.5 months and did not respond to therapy. After subsequent investigations, she was found to have TV endocarditis. She was not an IV drug abuser and did not have any underlying cardiac anomaly or any cardiac prosthesis implantation, which are common causes of right-sided endocarditis. This patient had responded to injection ceftriaxone 1 g IV/twice a day (bd), injection vancomycin 500 mg IV/bd, and injection gentamycin 80 mg IV/bd for total 28 days and was discharged to follow-up.

Tricuspid valve endocarditis following central venous cannulation: The increasing problem of catheter related infection

A central venous catheter (CVC) is inserted for measurement of haemodynamic variables, delivery of nutritional supplements and drugs and access for haemodialysis and haemofiltration. Catheterization and maintenance are common practices and there is more to the technique than routine placement as evident when a procedure-related complication occurs. More than 15% of the patients who receive CVC placement have some complications and infectious endocarditis involving the tricuspid valve is a rare and serious complication with high morbidity and mortality. Overenthusiastic and deep insertion of the guide wire and forceful injection through the CVC may lead to injury of the tricuspid valve and predispose to bacterial deposition and endocarditis. We report a case of tricuspid valve endocarditis, probably secondary to injury of the anterior tricuspid leaflet by the guide wire or the CVC that required open heart surgery with vegetectomy and repair of the tricuspid valve.

A Case of Mixed Serratia marcescens and Streptococcus mitis Endocarditis and Review of the Literature

In Brief Bacterial endocarditis due to Serratia species typically involves left-sided heart valves and is associated with a high mortality rate. We describe a case of polymicrobial Serratia marcescens and Streptococcus mitis tricuspid valve infection successfully treated with medical therapy. A review of the literature revealed 73 cases of endocarditis due to Serratia species, including 16 cases (21.9%) with mixed infection. Endocarditis due to Serratia is most frequently seen among injection drug users, and most cases (73.2%) involve left-sided valves. There is a high mortality rate (58.3%) overall, and risk factors for death included involvement of left-sided valves (odds ratio, 19.5; 95% CI, 3.0–126.4; P = 0.002) and evidence of metastatic infection (odds ratio, 8.5; 95% CI, 1.1–64.4; P = 0.039). Polymicrobial endocarditis involving Serratia species also has a high mortality rate (60%) and a predilection for left-sided valves (75%). Whereas our case recovered with a 6-week combination antibiotic regimen, the optimal treatment strategy is unknown. Sanchez et al. present a case of tricuspid valve endocarditis due to mixed Serratia marescens and Streptococcus mitis treated successfully with antibiotics alone. They reviewed the literature for cases of Serratia endocarditis and demonstrated a high mortality rate. In addition, left-sided endocarditis and evidence of metatstatic infections were associated with increased mortality

A Case of Tricuspid Valve Endocarditis with Large Vegetation due to St. Agalactiae and Rectal Carcinoma

A Case of Tricuspid Valve Endocarditis with Large Vegetation due to St. Agalactiae and Rectal Carcinoma

Candida Tricuspid Endocarditis in a Non-addict.

Isolated native non-rheumatic fungal tricuspid valve endocarditis is rarely described in the absence of intravenous drug addiction or use of intracardiac catheters or concomitant cardiac anomalies. Herein, we report a case of tricuspid valve endocarditis in a non-addict, which was successfully treated with valve replacement. The cultures of blood and vegetations revealed Candida Pichia Etschelsii. Candida tricuspid endocarditis must be considered in any patient with tricuspid vegetation, regardless of predisposing factors. </hea

Tricuspid valve endocarditis in an intravenous drug abuser masquerading as pulmonary tuberculosis

Intravenous drug abuse contributes to considerable illness burden in developed and developing countries. Tricuspid valve endocarditis (TVE) is rare in Middle East countries, though many reports of it in intravenous drug abusers are found in other countries. We describe a case of TVE mimicking pulmonary tuberculosis in a 33-year-old man with a history of intravenous heroin use.

First case of Pasteurella multocida endocarditis of the tricuspid valve: a favorable outcome following medical treatment

We describe a rare case of tricuspid valve endocarditis caused by Pasteurella multocida in an elderly woman with no previous history of valvular heart disease. Risk factors included contact with animals and old age. The patient was treated successfully with five days of intravenous ampicillin followed by four weeks of oral ciprofloxacin.

Metastatic myocardial abscess on the posterior wall of the left ventricle: a case report

IntroductionMyocardial abscess is a rare and potentially fatal condition. Metastatic myocardial abscess in the setting of infective endocarditis has been infrequently reported in the medical literature. To the best of the authors' knowledge no case of myocardial abscess affecting the free wall of the left ventricle secondary to infective endocarditis of a right-sided heart valve has been reported previously.Case presentationWe report a case of tricuspid valve endocarditis caused by Staphylococcus aureus and resulting in a myocardial abscess on the posterior wall of the left ventricle, far from the active valvular infection. We also briefly discuss the role of different investigation modalities including cardiac magnetic resonance imaging in diagnosing myocardial abscess.ConclusionMyocardial abscess is a life-threatening illness. A high index of clinical suspicion is required to make a prompt diagnosis. Final diagnosis may need multi-modality imaging. An early diagnosis, aggressive medical therapy, multidisciplinary care and timely surgical intervention may save life in this otherwise fatal condition.

Successful Treatment of Tricuspid Valve Endocarditis with Reconstruction of Leaflets Using Bovine Pericardium

Surgical treatments for tricuspid valve endocarditis include vegectomy, valvulectomy, valve repair, and valve replacement using cardiopulmonary bypass. Here, we present a case of tricuspid valve endocarditis in a heroin user with intractable infection, multiple pulmonary emboli, and a large vegetation after 2 months of antibiotic therapy. We reconstructed the leaflets with bovine pericardium and repaired the valve with the 'clover technique' to preserve the integrity of the tricuspid valve. This technique was described clinically by Alfieri in 2003, and was used to correct posttraumatic tricuspid regurgitation. An echocardiographic study was performed after the cardiopulmonary bypass, at discharge, and at follow-up. It revealed diminished tricuspid regurgitation from a severe preoperative degree to a minimal degree postoperatively and the patient recovered uneventfully.

Sepsis From Insidious Pacemaker Infection and Unsuspected Tricuspid Valve Endocarditis: The Importance of Transesophageal Echocardiography in Guiding Explantation Strategy

m E ACEMAKER GENERATOR POUCH and lead infection occur in 1% to 7% of patients with permanent pacemaker mplants.1,2 The diagnosis of infective pacemaker endocarditis emains a challenge because strict defining criteria are lacking, lthough several small retrospective studies and case reports ave emerged in recent years.1-3 The accepted and recomended treatment for patients with an infected pacemaker ystem is removal of the generator and lead extraction. Howver, in patients in whom large intracardiac vegetations are resent, cardiac surgery with cardiopulmonary bypass (CPB) ay be required to safely remove the infected pacemaker leads. A case of tricuspid valve endocarditis with intracardiac vegtations initially missed by preoperative transthoracic (TTE) nd transesophageal echocardiography (TEE) is presented. onversion to cardiac surgery with CPB was required for atrial nd ventricular pacing lead removal when another TEE docuented intracardiac vegetations and a patent foramen ovale uring attempted percutaneous extraction under fluoroscopic uidance. Intraoperative TEE, a standard tool for cardiac surery, is extremely helpful in cases of suspected pacemaker ndocarditis.

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

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.

Tricuspid Valve Endocarditis with Pulmonary Embolism Due to Postpartum Septicemia

Tricuspid valve endocarditis usually affects drug addicts without any preexisting heart disease. We report the successful surgical management of a case of tricuspid valve endocarditis with pulmonary artery embolism arising from postpartum septicemia.