Native Tricuspid Valve Endocarditis Research Articles

Tricuspid valve repair for infective endocarditis.

The progressive increase in the use of implantable electronic devices, vascular access for dialysis and the increased life expectancy of patients with congenital heart diseases has led in recent years to a considerable number of right-side infective endocarditis, especially of the tricuspid valve (TV). Although current guidelines recommend TV repair for native tricuspid valve endocarditis (TVE), the percentage of valve replacements remains very high in numerous studies. The aim of our study is to analyse our experience in the treatment of TVE with a reparative approach. This case series includes all the patients who underwent surgery for acute or healed infective endocarditis on the native TV, at the Cliniques Universitaires Saint-Luc (Bruxelles, Belgium) between February 2001 and December 2020. Thirty-one patients were included in the study. Twenty-eight (90.3%) underwent TV repair and 3 (9.7%) had a TV replacement with a mitral homograft. The repair group was divided into 2 subgroups, according to whether a patch was used during surgery or not. Hospital mortality was 33.3% (n = 1) for the replacement group and 7.1% (n = 2) for repair (P = 0.25). Overall survival at 10 years was 75.6% [95% confidence interval (CI): 52-89%]. Further, freedom from reoperation on the TV at 10 years was 59.3% (95% CI: 7.6-89%) vs 93.7% (95% CI: 63-99%) (P = 0.4) for patch repair and no patch use respectively. Freedom from recurrent endocarditis at 10 years was 87% (95% CI: 51-97%). Considering that TVE is more common in young patients, a repair-oriented approach should be considered as the first choice. In the case of extremely damaged valves, the use of pericardial patch is a valid option. If repair is not feasible, the use of a mitral homograft is an additional useful solution to reduce the prosthetic material.

A rare case of native tricuspid valve endocarditis caused by Aerococcus sanguinicola

• Aerococcus sanguinicola bacteremia is mostly seen in older males with urinary tract abnormalities or indwelling catheters. • Complicated bloodstream infections and infective endocarditis are rare. • More complicated infections are being reported due to improved methods for identification. • We describe the first presentation of right sided endocarditis caused by A. sanguinicola. An elderly man with no known valvular disease or history of intravenous drug use, intracardiac devices or central venous catheters was diagnosed with a tricuspid valve endocarditis and corresponding septic pulmonary emboli. Blood cultures showed Aerococcus sanguinicola being the likely causative pathogen. The patient did have a suprapubic catheter and bladder stones. Urinary tract abnormalities in older males and an indwelling urinary tract catheter are known risk factors for A. sanguinicola bacteremia but complicated bloodstream infections and infective endocarditis are rare. More complicated infections are being reported recently though possibly due to improved methods for identification. We describe a unique presentation of right sided endocarditis caused by A. sanguinicola to increase awareness of its potential to cause invasive disease.

MYCOTIC PULMONARY ARTERY PSEUDOANEURYSM TREATED WITH ENDOVASCULAR COILING

TOPIC: Procedures TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mycotic pulmonary artery pseudoaneurysm (PAP) presents with a focal dilatation of the affected vessel as a result of infection that leads to significant wall weakening. PSA can be life-threatening if rupture occurs, thus aggressive intervention is usually thought to prevent catastrophic hemorrhage. Coil embolization or stent placement are the most frequently used treatments. We present a case of right middle lobe (RML) pulmonary artery segmental branch pseudoaneurysm successfully treated with endovascular coiling in a patient with history of tricuspid valve (TV) endocarditis, bacteremia, and septic pulmonary emboli. CASE PRESENTATION: Patient is a 27-year-old female with past medical history of IV drug use and Hepatitis C. She had recently been hospitalized for 45 days due to methicillin-susceptible S. aureus (MSSA) bacteremia and native TV endocarditis with septic emboli to the lungs. 5 days prior to discharge, CT pulmonary angiogram showed a 1.8 cm enhancing lesion concerning for a pseudoaneurysm within medial segment of the RML. Subsequent outpatient evaluation by interventional radiology two weeks later revealed normal hemodynamic parameters (HR 87 bpm, BP 143/88 mmHg, RR 20 breaths/min, O2 sat 97% on room air), and unremarkable coagulation profile (including Hb of 11.3 g/dL and Hct of 35%). Endovascular embolization of the PAP was planned. Briefly, pulmonary artery was accessed using a 0.035-inch guidewire & pigtail catheter. Initial non-selective pulmonary angiogram demonstrated faint visualization of the RML PAP. Subsequent selective right pulmonary artery medial branch angiogram confirmed the location of the PAP. The pigtail catheter was exchanged for a vertebral artery catheter through which a PROGREAT® microcatheter was advanced into the pseudoaneurysm sac. Position of the catheter within the sac was confirmed. Coil embolization was performed using Concerto™ coils. Post-coiling RML pulmonary artery angiogram showed obliteration of the aneurysmal sac with preservation of distal vessels. The patient tolerated the procedure well and was discharged the following day. DISCUSSION: The etiology of PAPs can be iatrogenic, infectious, traumatic, or related to malignancy. When linked to infection, PAPs most commonly occur in the settings of TV endocarditis and septic embolism, with Staphylococcus and Streptococcus as the usual culprits. In our patient, IV drug use led to the development of MSSA bacteremia and TV endocarditis. The subsequent hematogenous spread of septic emboli to the pulmonary artery resulted in pseudoaneurysm formation. CONCLUSIONS: Mycotic PAPs can occur in patients with S. aureus TV endocarditis and can be treated with endovascular coil embolization. REFERENCE #1: Chen, Y., Gilman, M. D., Humphrey, K. L., Salazar, G. M., Sharma, A., Muniappan, A., Shepard, J.-A. O., & Wu, C. C. (2017). Pulmonary Artery Pseudoaneurysms: Clinical Features and CT Findings. American Journal of Roentgenology, 208(1), 84–91. https://doi.org/10.2214/AJR.16.16312 REFERENCE #2: Guillaume, B., Vendrell, A., Stefanovic, X., Thony, F., & Ferretti, G. R. (2017). Acquired pulmonary artery pseudoaneurysms: A pictorial review. In British Journal of Radiology (Vol. 90, Issue 1074). British Institute of Radiology. https://doi.org/10.1259/bjr.20160783 DISCLOSURES: No relevant relationships by Emad Chishti, source=Web Response No relevant relationships by Gaby Gabriel, source=Web Response No relevant relationships by Marianna Zagurovskaya, source=Web Response

Isolated Native Tricuspid Valve Endocarditis in a Nonintravenous Drug User

Infective endocarditis (IE) is a disease characterized by high morbidity and mortality. IE was first described in the mid-16th century. Right-sided infective endocarditis (RSIE) represents 5% to 10% of all IE episodes in adults. RSIE can be divided into three groups according to the underlying risk factors: intravenous drug users (IDUs), cardiac device carriers, and the “three noes” group (no left-sided IE, no IDUs, and no cardiac devices). Tricuspid valve endocarditis in nonintravenous drug users can occur in a variety of conditions including congenital heart disease, intracardiac devices, central venous catheters, and immunologically debilitated patients. Due to the rareness of isolated native nonrheumatic tricuspid valve endocarditis, here, we like to present an 18-year-old male from rural Ethiopia with the diagnosis of isolated native tricuspid valve endocarditis that was treated and cured.

Mycobacterium Abscessus Native Tricuspid Valve Endocarditis. Is a Six-Week Course of Combination Antibiotic Therapy Enough?

A 24-year-old Caucasian woman with a history of intravenous drug abuse and multiple hospital admissions for substance abuse related medical problems presented with pneumonia and was discharged home on oral antibiotics. Three days later, her blood culture grew acid fast bacilli, which was subsequently identified as M. abscessus subspecies abscessus. Transthoracic and transesophageal echocardiogram (TTE and TEE respectively) was suggestive of tricuspid valve (TV) endocarditis. CT scan of the chest showed evidence of septic pulmonary emboli, pneumonic consolidation and pleural effusion requiring chest tube placement. BAL and blood cultures grew Mycobacterium abscessus while pleural fluid cultures remained sterile. She was treated with a combination antibiotic therapy and completed a six-week course with resolution of her symptoms and microbiological cure. We present this rare case of M. abscessus native tricuspid valve endocarditis associated with lung infection treated with a short course of combination antibiotic therapy.

Treatment of tricuspid valve endocarditis with daptomycin and linezolid therapy

A case report of the use of linezolid and daptomycin for the treatment of multidrug-resistant right-sided infective endocarditis is presented. A 36-year-old patient with a history of intravenous drug use was hospitalized for treatment of native tricuspid valve endocarditis resulting in persistent methicillin-resistant Staphylococcus aureus bacteremia. During the admission the patient was unsuccessfully treated with vancomycin monotherapy (final E-test minimum inhibitory concentration, 4 μg/mL). The patient's treatment was switched to daptomycin and gentamicin, with no improvement in blood culture results over 4 days. Gentamicin was discontinued, and linezolid was administered in combination with daptomycin; bacteremia was cleared after 13 days of linezolid and daptomycin combination therapy. Due to daptomycin resistance (minimum inhibitory concentration, 4 μg/mL), gentamicin was substituted for daptomycin due to the former agent's synergistic effects with linezolid. After 23 days of therapy the patient was transferred to another facility for a tricuspid valve replacement procedure, which was completed without complications. The patient was transferred in stable condition to a skilled nursing facility to continue antibiotic therapy lasting 6 weeks from the date of surgery. The patient's blood cultures remained negative. A 36-year-old woman with resistant tricuspid valve endocarditis was successfully treated with linezolid in combination with daptomycin.

Mycobacterium abscessus causing native valve endocarditis due to peripherally inserted central catheter line

Infections due to rapidly-growing mycobacteria (RGM) are increasing worldwide, especially in immunocompromised hosts. However, data on the clinical features of patients with RGM bacteremia are limited [1]. Data on the incidence of clinically significant non-tuberculous mycobacteria (NTM) infections from India are scarce as these are frequently under-diagnosed due to either under recognition by clinicians because of the nonspecific nature of their clinical manifestations, and/or the inadequacy of laboratory services [2].We present a case of Mycobacterium abscessus native tricuspid valve endocarditis in a patient who had a peripherally inserted central catheter line (PICC).Clinicians need to be aware of RGM as a cause of prolonged fever in patients who have chronic indwelling intravenous catheters [3].

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.

An unusual case of native tricuspid valve endocarditis and sepsis in a child with structurally normal heart mimicking bronchopneumonia

An unusual case of native tricuspid valve endocarditis and sepsis in a child with structurally normal heart mimicking bronchopneumonia

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

Isolated tricuspid valve endocarditis

We present two non-HIV-infected patients with isolated native non-rheumatic tricuspid valve endocarditis who were not intravenous drug abusers. The patients presented with fever and chills. Plain radiography or high-resolution computed tomography of the chest revealed consolidation or infiltrate of the left parenchyma in both patients. Large vegetation located on the tricuspid leaflets was detected by transesophageal echocardiography. Staphylococcus aureus grew in two out of three blood cultures for one patient. Tricuspid valve endocarditis imitates illnesses with fever and pulmonary symptoms or signs of acute or chronic onset, and might be present even without abnormal chest X-rays or intravenous drug addiction.

An unusual native tricuspid valve endocarditis caused by Candida colliculosa

Candida colliculosa, which grew in blood cultures of a 71-year-old retired man with fever of unknown origin that had lasted for 7 months, in conjunction with transthoracic echocardiography, demonstrating a 20-mm vegetation, superior to the tricuspid valve, herniating into the right atrial cavity. The finding led to the diagnosis of fungal endocarditis. Fluconazole, 600 mg daily, was commenced for 8 days; followed by amphotericin B, 1 mg/kg daily. On the fourth day of the amphotericin B treatment, the patient underwent replacement of the infected tricuspid valve. Even though the initial postoperative period was relatively uncomplicated, the patient died after a gross aspiration on the 67th day of his hospital stay, despite aggressive cardiovascular support and antimicrobial therapy. This is the first report of a native tricuspid valve fungal endocarditis due to C. colliculosa or Torulaspora delbrueckii, which is not known to be a human pathogen.

Isolated Native Tricuspid Valve Endocarditis Caused by Viridans Streptococcus

The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.

Native tricuspid valve endocarditis in a young woman.

Accepted 23 April 1998 A 30-year-old woman was admitted having suffered from fever and malaise for about a month. During this period no drugs were taken, except antipyretics. On examination...

Isolated tricuspid valve endocarditis in nonaddicted patients: a diagnostic challenge.

Isolated native nonrheumatic tricuspid valve endocarditis rarely is described in the absence of intravenous drug use, intracardiac catheters, or cardiac anomalies. We diagnosed tricuspid valve endocarditis in two elderly nonaddicted patients with recurrent pulmonary infiltrates, anemia, and microscopic hematuria that occurred during several months and was caused by Gemella morbillorum and Candida glabrata, respectively. We have reviewed 27 other cases of nonaddicted patients with tricuspid valve endocarditis from the literature and discussed etiology, clinical characteristics, and outcome. Mean age was 53.5 years (range, 22 to 74 years old), and 72% had underlying medical conditions. Staphylococcus oureus, Streptococcus bovis, and candida species were the causative organisms in 70% of the cases. Average duration of infection before diagnosis was 9.3 months. We conclude that isolated tricuspid valve endocarditis in nonaddicted patients occurs mainly in the middle-aged and older persons, mimicking chronic illness and community-acquired pneumonia. In the absence of a history of intravenous drug use, diagnostic delays are common. We suggest that right-sided endocarditis must be considered in any patient with the "Tricuspid Syndrome," consisting of recurrent pulmonary events, anemia, and microscopic hematuria. Careful evaluation of prior medical records and clinical course can be very helpful. Echocardiography and serial blood cultures provide the key to diagnosis.