Right-sided Infective Endocarditis Research Articles

Right-sided infective endocarditis complicated with aortic pseudo aneurysms and systemic embolis in a 27 year old female with ventricular septal defect: a case report

Right-sided infective endocarditis complicated with aortic pseudo aneurysms and systemic embolis in a 27 year old female with ventricular septal defect: a case report

Severe cutaneous vasculitis as a symptom of right-sided infectious endocarditis in a patient with intravenous using of methadone: a clinical case

A bacterial infection of the heart’s endocardial surface causes infectious endocarditis (IE). The heart valves or an intracardiac devices are most affected. In most cases of right-sided endocarditis, the tricuspid valve is involved. Using drugs like cocaine, heroin, or any number of others can cause this disorder. Infective endocarditis can develop if methadone is not administered in accordance with the Methadone program, despite the cessation of drug use. In drug users, Staphylococcus aureus is the most common cause of right-sided infective endocarditis with pulmonary embolism and persistent bacteraemia. Cutaneous vasculitis, particularly leukocytoclastic vasculitis, is a rare manifestation of IE.

Late Manifestation of Congenital Heart Disease: Right-side Infective Endocarditis and the Mystery of the Unseen Ventricular Septal Defect: Case Report

Infective endocarditis (IE) is a severe complication in patients with congenital heart disease. However, CHD-associated mortality has decreased to 10% because of improvements in the diagnosis of infective endocarditis, antibiotic therapy, cardiac surgery, and interventional procedures. Herein, we aimed to illustrate a case of right-sided infective endocarditis associated with an unknown ventricular septal defect, complicated by septic pulmonary emboli as a rare form of delayed presentation of congenital heart disease.
 The significant occurrence of infective endocarditis prompts the need for additional investigations into the current utilization, necessity, and effectiveness of antibiotic prophylaxis in patients with congenital heart disease (CHD).

Infective endocarditis of tricuspid valve following septic abortion: a case report

Introduction: Right-sided infective endocarditis (IE) in non-intravenous drug users is a rare finding. IE of the tricuspid valve is considered an important but uncommon complication in patients with a recent history of obstetric and gynecological procedures. Case presentation: We report a case of a 28-year-old female with IE of the tricuspid valve with a prior history of dilatation and curettage. The echocardiography revealed two mobile vegetation in the septal leaflet of the tricuspid valve with severe eccentric tricuspid regurgitation. Blood culture was positive for Staphylococcus aureus. The patient was started on intravenous (i.v.) antibiotics with supportive treatments and improved over the days. Clinical discussion: Infection can get access to the venous system via pelvic veins after the septic obstetric and gynecological procedure and subsequently to the right side of the heart. Different studies have highlighted the role of prophylactic antibiotics in significantly reducing post-abortal infections. In our patient, the disease was diagnosed on the basis of clinical, echocardiographic, and blood culture findings, and the patient responded well to i.v. antibiotics and supportive care under close monitoring in the coronary care unit. Conclusion: It is important for healthcare providers to be aware of the risk factors and symptoms associated with right-sided IE for early diagnosis and treatment. Appropriate antibiotic prophylaxis and adherence to sterile techniques can help to prevent IE.

Right-sided infective endocarditis of a native valve with multiple embolus lesions.

Right-sided infective endocarditis of a native valve with multiple embolus lesions.

Multidisciplinary Approach to the Management of a Patient with Right-Sided Infective Endocarditis on Maintenance Hemodialysis

Infective endocarditis in patients on maintenance hemodialysis occurs more often than in the population, manifests severe complications and is characterized by high mortality. The management of such patients requires the participation of several specialists. In the presented clinical observation, both typical characteristics of infective endocarditis on maintenance hemodialysis (staphylococcal etiology, association with vascular access devices, metabolic and hemodynamic risk factors) and peculiarities of a particular case (nature of nephropathy that led to maintenance hemodialysis, mechanism of right heart damage, which is uncommon for infective endocarditis on maintenance hemodialysis) are discussed in comparison with literature data. Interdisciplinary interaction of doctors of several specialties contributed to the choice of the right tactics and a favorable outcome of the disease.

Evaluation of epidemiological and microbiological characteristics, clinical features, and outcomes of adult patients with infective endocarditis in Mashhad, Iran.

Infective endocarditis (IE) is a serious problem with high morbidity and mortality. However, there is a paucity of data regarding its epidemiology in non-high-income settings. Here, we described the characteristics of patients with IE. Between March 2012 to March 2020, all adults (≥ 16 years) with a diagnosis of IE who were admitted to a university hospital in Mashhad, Iran, were included in the study. We evaluated 46 cases of IE with a median age of 42 years (interquartile range 31 to 58.3 years), of whom 21 (46%) had a definite diagnosis. The presence of a prosthetic valve or intracardiac device was the leading predisposing factor (N = 14, 30%). The etiology of IE in 22 subjects (48%) remained unknown. Staphylococcus aureus (N = 12, 26%) was the most common causative pathogen. Echocardiography revealed the mitral valve as the most affected valve (N = 18, 39%). Intravenous drug users (IVDU) had a higher chance of right-sided IE, as compared to no IVDU patients (odds ratio: 35, 95% CI: 3.7 to 425.0). The most prevalent complications were lung infarction, acute heart failure, and neurologic involvement (N = 5, 11% for each), and 15 patients (33%) died because of IE. In our study, the median age of IE onset was relatively low. The most frequent predisposing factor was a prosthetic valve or intracardiac device. The proportion of negative blood cultures was unacceptably high. Thus, our findings emphasize promoting laboratory infrastructure, developing a national protocol for early initiation of appropriate treatment, and eliminating predisposing factors.

Postoperative complications and predictors of mortality in surgery for left-sided infective endocarditis: a single-center retrospective study

Aim. To assess postoperative complications and predictors of mortality in surgery for left-sided infective endocarditis (IE).Material and methods. The retrospective analysis included 222 cases of IE in 216 patients who were operated on from January 2015 to November 2022. Inclusion criteria: age of patients ≥18 years, definite or probable (Duke criteria) left-sided IE of aortic and/or mitral valves. There were following exclusion criteria: isolated right-sided IE (tricuspid valve, pacemaker endocarditis), nonbacterial thrombotic endocarditis and chronic IE. Endpoints: inhospital mortality, postoperative complications (delirium; perioperative stroke; resternotomy for bleeding; perioperative myocardial infarction; acute heart failure requiring extracorporeal membrane oxygenation or intra-aortic balloon pumping; respiratory failure requiring tracheostomy; acute kidney injury requiring renal replacement therapy; conduction disorder requiring pacemaker implantation).Results. Median age was 53 [38,0; 61,0] years, while the majority of patients were men (73,9%). Inhospital mortality was 8,6%. The most common postoperative complications were delirium (19,8%) and bleeding requiring resternotomy (10,4%). The incidence of perioperative stroke was 2,3%, perioperative myocardial infarction - 0,9%, respiratory failure with tracheostomy – 4,5%, pacemaker implantation – 2,7%, renal replacement therapy – 6,8%. According to multivari ate analysis, Predictors of inhospital mortality were creatinine clearance level (odds ratio (OR), 0,976; 95% confidence interval (CI): 0,956-0,996; p=0,020), time of cardiopulmonary bypass (OR, 1,014; 95% CI: 1,006-1,021 , p<0,001), deli rium (OR, 7,058; 95% CI: 1,824-27,330, p=0,005) and acute kidney injury requiring renal replacement therapy (OR, 28,620; 95% CI: 6,508-125,964; p<0,001).Conclusion. Surgical treatment of left-sided IE has satisfactory inho spital outcomes. The study identified simple clinical factors (creatinine clearance, cardiopulmonary bypass time, delirium, acute kidney injury) associated with inhospital mortality.

Postoperative complications and predictors of mortality in surgery for left-sided infective endocarditis: a single-center retrospective study

Aim. To assess postoperative complications and predictors of mortality in surgery for left-sided infective endocarditis (IE).Material and methods. The retrospective analysis included 222 cases of IE in 216 patients who were operated on from January 2015 to November 2022. Inclusion criteria: age of patients ≥18 years, definite or probable (Duke criteria) left-sided IE of aortic and/or mitral valves. There were following exclusion criteria: isolated right-sided IE (tricuspid valve, pacemaker endocarditis), nonbacterial thrombotic endocarditis and chronic IE. Endpoints: inhospital mortality, postoperative complications (delirium; perioperative stroke; resternotomy for bleeding; perioperative myocardial infarction; acute heart failure requiring extracorporeal membrane oxygenation or intra-aortic balloon pumping; respiratory failure requiring tracheostomy; acute kidney injury requiring renal replacement therapy; conduction disorder requiring pacemaker implantation).Results. Median age was 53 [38,0; 61,0] years, while the majority of patients were men (73,9%). Inhospital mortality was 8,6%. The most common postoperative complications were delirium (19,8%) and bleeding requiring resternotomy (10,4%). The incidence of perioperative stroke was 2,3%, perioperative myocardial infarction - 0,9%, respiratory failure with tracheostomy – 4,5%, pacemaker implantation – 2,7%, renal replacement therapy – 6,8%. According to multivari ate analysis, Predictors of inhospital mortality were creatinine clearance level (odds ratio (OR), 0,976; 95% confidence interval (CI): 0,956-0,996; p=0,020), time of cardiopulmonary bypass (OR, 1,014; 95% CI: 1,006-1,021 , p<0,001), deli rium (OR, 7,058; 95% CI: 1,824-27,330, p=0,005) and acute kidney injury requiring renal replacement therapy (OR, 28,620; 95% CI: 6,508-125,964; p<0,001).Conclusion. Surgical treatment of left-sided IE has satisfactory inho spital outcomes. The study identified simple clinical factors (creatinine clearance, cardiopulmonary bypass time, delirium, acute kidney injury) associated with inhospital mortality.

A Rare Case of Postpartum Native Tricuspid Valve Infective Endocarditis with Septic Pulmonary Embolization

Infective endocarditis (IE) is a rare life-threatening infection in pregnancy and postpartum period. In 90% of cases, right-sided IE involves the tricuspid valve. This case report illustrates acute IE with native tricuspid valve vegetation with septic pulmonary embolization in immediate postpartum period.

Right-Sided Infective Endocarditis

Right-sided infective endocarditis (RSIE) is relatively rare, accounting for only 5 to 14% of all cases of infective endocarditis (IE). Its incidence is increasing due to the growing use of intravascular and intracardiac devices, as well as the rising prevalence of intravenous drug use. What distinguishes RSIE is that it often occurs on previously healthy valves. It can be associated with left-sided involvement (infective endocarditis with interventricular communication or complicated by septal perforation) or be limited to the valvular orifices of the right heart, more commonly affecting the tricuspid valve than the pulmonary valve. The diagnosis is established based on the Duke criteria. The prognosis can be poor, and the treatment primarily relies on antibiotic administration, with surgery reserved for specific indications related to vegetation size, hemodynamic issues, or infectious complications.

The three-noes right-sided infective endocarditis: An unrecognized type of right-sided endocarditis.

The "3 noes right-sided infective endocarditis" (3no-RSIE: no left-sided, no drug users, no cardiac devices) was first described more than a decade ago. We describe the largest series to date to characterize its clinical, microbiological, echocardiographic and prognostic profile. Eight tertiary centers with surgical facilities participated in the study. Patients with right-sided endocarditis without left sided involvement, absence of drug use history and no intracardiac electronic devices were retrospectively included in a multipurpose database. A total of 53 variables were analyzed in every patient. We performed a univariate analysis of in-hospital mortality to determine variables associated with worse prognosis. the study was comprised of 100 patients (mean age 54.1 ± 20 years, 65% male) with definite 3no-RSIE were included (selected from a total of 598 patients with RSIE of all the series, which entails a 16.7% of 3no-RSIE). Most of the episodes were community-acquired (72%), congenital cardiopathies were frequent (32% of the group of patients with previous known predisposing heart disease) and fever was the main manifestation at admission (85%). The microbiological profile was led by Staphylococci spp (52%). Vegetations were detected in 94% of the patients. Global in-hospital mortality was 19% (5.7% in patients operated and 26% in patients who received only medical treatment, P < .001). Non-community acquired infection, diabetes mellitus, right heart failure, septic shock and acute renal failure were more common in patients who died. the clinical profile of 3no-RSIE is closer to other types of RSIE than to LSIE, but mortality is higher than that reported on for other types of RSIE. Surgery may play an important role in improving outcome.

Outcomes and survival of patients undergoing percutaneous vegetectomy for right heart endocarditis

BackgroundsAngioVacis used for the percutaneous removal of vegetations and fordebulking of large vegetations in patients who are not surgical candidates.This study aims to identify thedemographics, echocardiographic features, indications, improvement of the tricuspid valve regurgitation, and survival outcomes of patients who have undergone AngioVac vegetectomy reported in the literature. MethodsA systematic review was performed to identify articles reporting suction thromectomy or vegetation removal using the AngioVac system for RSIE (right sided infective endocarditis). Survival on discharge was our primary outcome. Additionally, we evaluated indications for suction thrombectomy and TR improvement.Categorical variables were expressed as percentages and ratios. ResultsA total of 49 studies were identified. The most common risk factor was intravenous drug abuse seen in 45% (20/49) and cardiovascular implantable electronic device (CIED) in 45% (20/49). Circulatory shock was seen in 35% of patients. The causative organism was gram positive cocci (86%).Moderate to severe TRwas present in 74% of cases with documented echocardiograms. Indications for AngioVacwerepoor surgical candidacy (81%) or to reduceseptic emboli risk(19%). Survival at dischargewas 93%.TR improvement was reported only in 16% cases and remained unchanged/worsened in 84%. ConclusionAngioVac procedure is an alternative treatment for critically ill patients who cannot undergo surgery. To understand the survival, safety and candidacy of patients undergoing this procedure, further randomized control studies and literature reviews are needed. The improvement or worsening of tricuspid regurgitation in patients with TR valve involvement is another factor to be investigated.

Right-sided infective endocarditis: characterization and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Right-sided infective endocarditis (RIE) involves native/prosthetic valves and any intracardiac devices present in the right cavities. It's caused by the seeding of any of these structures by bacterial or, less commonly, fungal organisms. It's commonly associated with intravenous drug use, intracardiac devices and central venous catheters, all of which became more prevalent over the past 20 years. Purpose We aimed to characterize the patients with right-sided infective endocarditis, including device endocarditis, admitted to our center and compare them with patients admitted with left-sided infective endocarditis (LIE). Methods We performed a retrospective study of a group of patients (pts) with infective endocarditis (IE) admitted to our center from 2000 to 2020. Pts were categorized with right-sided endocarditis when presented with endocarditis of the native/prosthetic valves right-sided and intracardiac devices. We considered, as composite endpoint, deaths, embolic events and recurrence of endocarditis in a medium follow-up of 37.4 ± 46.0 months. Results A total of 160 pts (106 males, mean age 66,3 ± 16 years) with the diagnosis of IE were included. 32 pts had RIE (11 with involvement of tricuspid valve and 23 with device involvement) and 126 had LIE (100 of native valve and 26 of prosthetic valve). We had 56 (15.5%) pts referred to surgery during hospitalization and 27 (7.5%) died during hospitalization. Compared with LIE, most of the pts with RIE were males (84% versus 61%, p= 0,015). The mean age was similar between the groups (p= 0,584). Pts with RIE had a lesser prevalence of known valvular heart disease (48% versus 21%, p= 0,007). Concerning complications of endocarditis, pts with RIE had less prevalence of fistula (18% versus 0%, p= 0,021). During hospitalization, the proportion of pts undergoing surgery was significantly less in patients with RIE (31% vs 61%, p=0,001). Considering the subgroup of patients with device endocarditis, 14 patients undergo device extraction (8 percutaneous and 6 surgical extraction). During a mean follow-up duration of 37.4 ± 46.0months, pts with the diagnosis of RIE had better outcomes for the composite endpoint (61% vs 33%, p=0.003). Even when we considered the events during the hospitalization (namely embolic events or death), this subgroup had fewer events (83% vs 63%, p=0.034). In a multivariate regression analysis, after adjusting for all the confounders (previous cardiac failure, development of severe valvular regurgitation, presence of fistula/perforation and development of abscess), RIE was an independent predictor of less prevalence of the composite endpoint (HR 0.38; 95% CI: 0.19-0.79). Conclusions RIE was associated with a better outcome, when considering death, embolic events, or recurrence of endocarditis. The patients with right-sided endocarditis were also less frequently submitted to surgery compared to others.

Characteristics and outcomes of angiovac-assisted debulking of intracardiac masses, thrombi, and endocarditis.

Traditional management for right-sided infective endocarditis and other adherent masses centers around balancing the risks and benefits of open surgical removal against medical therapy. Single-center study analysis of 19 patients who underwent vacuum-assisted debulking and/or en bloc removal of right-sided infective endocarditis and other adherent masses between September 2017 and November 2021. Clinical outcomes during the perioperative period, postoperative period, hospital course, and post-discharge were analyzed. We included 12 male and 7 female patients with an average age 47.4 ± 16.8. Relevant risk factors included 47.4% of patients with active intravenous drug use (IVDU), 21.1% of patients with a history of permanentpacemaker (PPM) or implantable cardioverter-defibrillator (ICD), and 5.3% of prior malignancy with mediastinal radiation. 31.6% of patients had documented right-sided masses from a non-infectious etiology, while 68.4% of patients were noted to have right-sided infective endocarditis (RSIE). All patients were found to have large, mobile masses or vegetations at high risk for embolization to the pulmonary vasculature. Average in-hospital length of stay was 17.8 ± 12.2days, blood cultures cleared postoperatively in 8.9 ± 7.3days, periprocedural mortality was 0%, subsequent open surgical valvular repair during the same admission was 5.3%, and in-hospital mortality was 5.3%. Within 6weeks of follow-up, 15.8% of patients were readmitted for recurrence of bacteremia, 10.5% of patients were found to have new pulmonary embolism, and 15.8% of patients underwent open surgical valvular repair. Total death after 1-year and 2-years was 15.8% and 5.3%, respectively. Recurrence of bacteremia was 21.1% within 1-year. AngioVac is a viable therapeutic strategy for select patients with intravascular and intracardiac right-sided masses including thrombi, emboli, or infective masses such as endocarditis.

1990. Prognostic factors for long-term mortality in left-sided infective endocarditis after surgical treatment

Abstract Background Infective endocarditis is not a prevalent disease but has a high mortality rate. Especially left-sided infective endocarditis (LSIE) shows a higher mortality rate than right-sided infective endocarditis. Surgical treatment is occasionally considered for LSIE, but not much data is available on the long-term prognostic factors for LSIE after surgical treatment. This study investigated the risk factors for long-term mortality in LSIE patients who underwent surgical treatment. Methods This retrospective study enrolled adult patients with LSIE admitted to Severance Hospital in South Korea and underwent surgical treatment from November 2005 to August 2017. The primary outcome was overall all-cause mortality. Multivariate Cox regression analyses were performed to assess the risk factors for long-term mortality of LSIE with surgical treatment. Results 239 cases with LSIE who underwent surgery were enrolled in this study. The median follow-up period was 6.2 years, and there were 34 deaths (14.2%) during the period. The mortality group showed older age (61.0 [53.0-72.0] vs 51.0 [39.0-61.0] years, P = 0.001), more chronic kidney disease (17.6% vs 3.9%, P = 0.007), more chronic liver disease (CLD) (14.7% vs 3.4%, P = 0.017), more cerebral embolisms (58.8% vs 26.8%, P &amp;lt; 0.001), less isolated mitral valve involvement (29.4% vs 52.7%, P = 0.020), and higher Sequential Organ Failure Assessment score (2.0 [1.0-4.0] vs 1.0 [1.0-2.0], P = 0.014). The survivor and mortality groups showed no statistical difference in the time to surgery. Multivariate Cox analyses demonstrated cerebral embolism (Hazard ratio (HR): 3.62, 95% Confidence Interval (CI): 1.79-7.31, P &amp;lt; 0.001), CLD (HR: 4.24, CI: 1.53-11.76, P = 0.005), and age (HR: 1.03, CI: 1.00-1.06, per 1 year, P = 0.021) as risk factors for overall mortality. Kaplan-Meier survival curve showed significant difference between the patients with and without cerebral embolism (P &amp;lt; 0.001, log-rank). Figure 1.Kaplan-Meier survival curve for overall mortality Conclusion Cerebral embolism, CLD, and older age were associated with the long-term mortality in LSIE patients who underwent surgery. Preventive strategies for cerebral embolism are essential for the improvement in LSIE treatment. Disclosures All Authors: No reported disclosures.

Septic Pulmonary Embolism: A Contemporary Profile.

Septic pulmonary embolism (SPE) is a rare clinical entity that is distinct from the classic and more common non-septic thrombotic pulmonary embolism. SPE should be suspected in patients with a systemic acute inflammatory reaction or sepsis who develop signs and symptoms of pulmonary involvement. The diagnosis of SPE depends on the specific radiologic finding of multiple, peripheral, nodular, possibly cavitated lesions. SPE should prompt an immediate search for the primary source of infection; typically, right-sided infective endocarditis, cardiac implantable electronic devices, and septic thrombophlebitis as a complication of bone, skin, and soft tissue infection including Lemierre's syndrome, indwelling catheters, or direct inoculation via injection drug use. Invasive treatment of the infection source may be necessary; in thrombophlebitis, the efficacy and safety of anticoagulation remain undefined. Blood cultures may be negative, particularly among patients with recent antibiotic exposure, and broad-spectrum antimicrobial therapy should be considered. The in-hospital mortality of SPE ranges up to 20% in published case series. While trends in the incidence of SPE are unknown, the opioid epidemic, the growing use of cardiac implantable electronic devices worldwide, and the reported increase in cases of septic thrombophlebitis may be leading to an escalation in SPE cases. We provide a contemporary profile of SPE and propose a clinical management algorithm in patients with suspected or confirmed SPE.

Abstract 10564: Angiovac for Vegetation Debulking in Right-Sided Infective Endocarditis: A Systematic Review and Meta-Analysis

Objectives: To investigate the utility of AngioVac-assisted vegetation debulking (AVD) in right sided infective endocarditis (RSIE) Background: AngioVac is a vacuum-based device that was approved in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Although there are multiple reports on the use of the AngioVac device to aspirate right-sided heart chamber thrombi, data on its use to treat RSIE is limited. Methods: We performed a comprehensive literature search for studies that evaluated the utility of AVD. The primary outcomes of our study were the procedural success, defined as the ability of AngioVac to produce residual vegetation size &lt;50% (RVS&lt;50%) without serious procedural complications, and the clinical success, defined as composite of RVS&lt;50%, in-hospital survival, absence of recurrent bacteremia, and valve function not requiring further intervention. The secondary outcomes included the individual components of the primary outcomes and average length of hospital stay. The pooled means and proportions of our data were analyzed using random-effects model, generic inverse variance method, and represented with 95% confidence intervals (CIs). Results: A total of 44 studies, including 301 patients (mean age: 44.6±18.2 years, 71.6% males) were included. Procedural success was achieved in 89.2% of patients (95% CI:82.3%-93.6%, I 2 =0%). Clinical success was achieved in 79.1% of patients (95%CI:67.9%-87.2%, I 2 =15%). Overall survival rate was 89.7% (95% CI:83.1%-93.9%%, I 2 =9%). Conclusions: Our meta-analysis demonstrates that AVD is a promising therapeutic option for RSIE offering a high success rate with a low complication rate across a wide range of patients.

Abstract 13195: A Case of Ebstein Anomaly Diagnosed Following Tricuspid and Pulmonic Valve Infective Endocarditis in an Adult Patient

Background: We present a rare case of infective endocarditis (IE) involving both tricuspid (TV) and pulmonic valves (PV) in the setting of newly diagnosed Ebstein anomaly (EA) with isolated, small membranous VSD. Case: A 48 yo woman with no known medical history presented with two weeks of fever, flu-like symptoms, and dyspnea. Vitals showed fever, tachycardia, and tachypnea. Poor dentition, grade III systolic murmur, and S3 gallop were noted on physical exam. EKG showed sinus tachycardia and right bundle branch block. Laboratory studies showed leukocytosis and elevated CRP. A chest CT revealed bilateral lung infiltrates in a rounded configuration concerning for septic emboli. Blood cultures grew Streptococcus mitis , and IV antibiotics were initiated. TTE revealed 3.2cm apical displacement of the TV resulting in right ventricular atrialization, diagnostic for EA. TTE also found a 26x17mm vegetation on the septal and anterior leaflets of the TV with moderate tricuspid regurgitation and an 11x6mm vegetation on the PV, confirmed by TEE. Cardiac MRI also noted a focal aneurysm of the membranous interventricular septum with a hemodynamically insignificant shunt. Discussion: While interatrial communications are seen in a majority of EA patients (80-94% of cases), this patient presented solely with a small membranous VSD and absence of ASD and PFO. Moreover, this patient had no PDA to depend on for pulmonary flow. Remarkably, she had an asymptomatic course with EA until the development of endocarditis. It is believed the presence of an isolated VSD in this patient’s severe EA likely promoted forward pulmonic flow in an already inadequate right ventricle. Right-sided IE is itself rare (5-10% of cases) with isolated PV involvement being even rarer (2% of cases). This patient’s uncorrected EA with redundant TV and PV leaflet tissue likely contributed as a nidus for simultaneous infection of both valves.

Outcomes After Tricuspid Valve Operations in Patients With Drug-Use Infective Endocarditis

The increase of intravenous drug use has led to an increase in right-sided infective endocarditis and its complications including septic pulmonary embolism. The objective of this study was to compare the outcomes of tricuspid valve (TV) operations in patients with drug-use infective endocarditis (DU-IE) complicated by septic pulmonary emboli (PE). Hospitalizations for DU-IE complicated by septic PE were identified from the National Inpatient Sample from 2002 to 2019. Outcomes of patients who underwent TV operations were compared with medical management. The primary outcome was the incidence of major adverse cardiovascular events (MACEs), defined as in-hospital mortality, myocardial infarction, stroke, cardiogenic shock, or cardiac arrest. An inverse probability of treatment weighted analysis was utilized to adjust for the differences between the cohorts. A total of 9,029 cases of DU-IE with septic PE were identified (mean age 33.6years), of which 818 patients (9.1%) underwent TV operation. Surgery was associated with a higher rate of MACE (14.5% vs 10.8%, p <0.01), driven by a higher rate of cardiogenic shock (6.1% vs 1.2%, p <0.01) but a lower rate of mortality (2.7% vs 5.7%, p <0.01). Moreover, TV operation was associated with an increased need for permanent pacemakers, blood transfusions, and a higher risk of acute kidney injury. In the inverse probability treatment weighting analysis, TV operation was associated with an increased risk for MACE driven by a higher rate of cardiogenic shock and cardiac arrest, but a lower rate of mortality when compared with medical therapy alone. In conclusion, TV operations in patients with DU-IE complicated by septic PE are associated with an increased risk for MACE but a decreased risk of mortality. Although surgical management may be beneficial in some patients, alternative options such as percutaneous debulking should be considered given the higher risk.