Surgical treatment for tricuspid valve infective endocarditis. Reported here is a case of infective endocarditis caused by the saprophytic species neisseria cinerea. We describe a 57yearold patient with no history of parenteral drug addiction or vascular catheter use, who had tricuspid valve endocarditis in a morphologically normal valve. Tricuspid valve repair was performed in 9 patients whose valves had infective lesions involving a single leaflet. Tricuspid valve endocarditis due to neisseria cinerea.
Pdf tricuspid valve endocarditis in a child with structurally normal. Among them, about 90% involve the tricuspid valve tv. Tricuspid valve infective endocarditis is an infrequent diagnosis, accounting for only 5 to 10 % of all cases of infective endocarditis, and is most common in intravenous drug users 1, 2. Tricuspid valve infective endocarditis complicated with. Although antibiotic therapy is the initial mode of therapy in these patients, surgical replacement of the infected valve may have to be done in those. After resection of the diseased anterior leaflet, he valve was reconstructed with autologous. Surgeons can play a role by bringing the problem of epidemic of drug use to public consciousness. In 7 the causative microorganism was a staphylococcus, and autopsy in the 4 patients who died revealed infection of the tricuspid valve. The tricuspid valve usually has three leaflets, named the anterior, posterior, and septal leaflets. An operation was indicated because the echocardiography showed massive vegetation on the anterior leaflet of the tricuspid valve and severe regurgitation even though the endocarditis was healed with drug therapy. This study seeks to compare tricuspid valve repair, replacement, and excision for the treatment of infective endocarditis methods. Two types of abnormality were noted on the echocardiogram of the tricuspid valve. Isolated tricuspid valve infective endocarditis is an infrequent diagnosis, the incidence of tricuspid valve infective.
Tricuspid valve endocarditis in a nonaddicted patient. Risk and outcomes of aortic valve endocarditis among. We report a case of aortic and tricuspid valve infective endocarditis caused by streptococcus suis, which required cardiac surgery. The vast majority of rsie cases involve the tricuspid valve tv, with pulmonic valve involvement accounting for less than 10% of all rightsided cases. Q fever is a rare systemic infection caused by coxiella burnetii. We report a case of q fever endocarditis involving the tricuspid and aortic valves and a congenital ventricular septal defect. In 2012, she was diagnosed with endocarditis of the bioprosthetic tricuspid. Streptococcus bovis endocarditis has 18%62% association with colonic neoplasms with multivalvular involvement and affects mainly elderly males leading to severe cardiac dysfunction, septic embolization, and neurological complications.
Tricuspid valve endocarditis american board of family medicine. Infective endocarditis presenting with arthralgia is rare. Rightsided ie rsie is relatively rare, encompassing only 510% of ie cases 1,2. Pdf on jun 1, 2012, guillermo martinez and others published infective endocarditis find, read and cite all the research you need on.
Prevalence and characteristics of tricuspid valve endocarditis. A single center cardiac surgery database was queried between 2012. The bicuspid aortic valve was first described as a pathological curiosity in 1844 by paget. If the cause of ie is injection of illicit drugs or prolonged use of iv drugs, the tricuspid valve is. Abbreviations and acronyms 3d 3dimensional ie infective endocarditis ivda intravenous drug abuse tee transesophageal. Major risk factors for tv infective endocarditis tvie are intravenous drug use, pacemaker pm leads and indwelling vascular accesses 1,2. Infective endocarditis of the tricuspid valve is often seen in drug addicts who use the intravenous route. Cusp commissuroplasty for tricuspid valve endocarditis. We report the case of a 30yearold caucasian woman who presented with painful swelling of her wrists and ankles. Tricuspid valve endocarditis marincuartas annals of.
Aortic valve prosthesis endocarditis with involvement in mitral and tricuspid valve duration. Eight of these patients had associated mitral valve prolapse. The case of a 50yearold nondrug addict patient presenting with tricuspid valve infective endocarditis ie by mrsa resistant to vancomycin and linezolid is presented. Streptococcus suis is a zoonotic pathogen that causes invasive infections in humans. Heart valves and infective endocarditis american heart. During the study period, 63 patients underwent surgical treatment of infective tricuspid valve endocarditis. Tricuspid stenosis in prosthetic valve endocarditis chest. The patient was an intravenous drug addict who developed tricuspid endocarditis with lung embolism. Objective patients with structural abnormalities of cardiac valves, including bicuspid aortic valve bav, are said to be at higher risk of infective endocarditis ie.
Information gleaned from intraoperative transesophageal echocardiographic imaging and realtime measurements was used to effectively modify procedural hardware and successfully treat the patient using an aspirationbased strategy. The clinical debut was characterized by acute febrile syndrome, purpura petechia on the legs, and oligoarthritis. Only 510% of infective endocarditis ie cases are reported to be rightsided ie with more than 90% of these cases involving the tricuspid valve. Each leaflet is connected via chordae tendineae to the anterior, posterior, and septal papillary muscles of the right ventricle, respectively. Tricuspid valve replacement was performed in 74 patients 58. Staphylococcal tricuspid endocarditis in heroin addicts. Notably, she received antibiotics prior to obtaining blood cultures. The echocardiographic findings in 12 patients with tricuspid valve prolapse are presented. Isolated tricuspid valve endocarditis international journal of. In tricuspid valves that are too loose, tissue can be used to fill in leaky parts so that tricuspid regurgitation no longer occurs. From july 2011 to december 2016, 16 patients with intravenous drugassociated tricuspid valve endocarditis underwent isolated tricuspid valve operations for endocarditis.
Rightsided infective endocarditis rsie encompasses 510% of all infective endocarditis ie cases. Journal of community hospital internal medicine perspectives. Tricuspid valve replacement with a mitral homograft for. There were a total of 752 patients with infective tricuspid valve endocarditis, of which 14% underwent valvectomy and 86% underwent replacement mean followup 4. Infective endocarditis cured by resection of a tricuspid. Tricuspid and aortic valve and ventricular septal defect. Tricuspidvalve repair for pacemaker leads endocarditis. Most tricuspid valve ie cases are strongly associated with. Second, the frequency of tricuspid valve endocarditis has increased significantly, owing largely to an increasing population of injection drug users, patients with implanted cardiac devices or longterm central venous catheters, and, to a lesser extent, a growing number of immunocompromised patients. Reoperation, stroke and renal failure requiring dialysis during the index hospitalization were 5. Bioprosthetic cardiac valves may be particularly prone to this complication. Tricuspid valve leaflet repair and augmentation for. Aortic and tricuspid valve infective endocarditis caused.
A case of candida tricuspid endocarditis occurred with widespread systemic involvement, including central nervous system candidiasis. Surgical management of infective endocarditis hellenic journal of. Tricuspid valve endocarditis in a nonaddicted patient without. Tricuspid valve endocarditis does not usually result in any detectable murmur,7 which complicates diagnosis. Tricuspid valve endocarditis in a patient with congenital. Optimum surgical treatment for tricuspid valve infective. Only one of the above patients had the characteristic physical signs of tricuspid incompetence. The disease was cured after treatment with ampicillinclavulanate that was. Tricuspid valve reconstruction for endocarditis youtube.
A case of bioprosthetic tricuspid valve endocarditis with stenosis diagnosed by doppler echocardiography and confirmed by operative. These patients were characterized clinically by a triad of heroin addiction, septicemia, and pulmonary infarction in the absence of peripheral venous disease. Infective endocarditis ie is a disease characterized by high morbidity and mortality. Pdf we report a case of isolated tricuspid valve endocarditis endocarditis afflicting a structurally normal heart due to. Rightsided infective endocarditis is strongly associated with intravenous drug use, and 90% of rightsided endocarditis involves the tricuspid valve. Prosthetic valve endocarditis, however, is more commonly associated with obstruction. Valvectomy versus replacement for the surgical treatment. Surgical treatment for isolated tricuspid valve endocarditis. During the period of the opioid epidemic, tricuspidrelated endocarditis rates have increased, while the incidence of surgery for tricuspid endocarditis has increased as much as fivefold. Relapsing tricuspid valve endocarditis by multidrugresistant pseudomonas aeruginosa in 11 years. Risk factors for adults include previous valve surgeries or a heart transplant, calcium deposits in the mitral valve or in the aortic valve, congenital heart defects or a history of endocarditis. In no case was there a history of intravenous drug use. Infective endocarditis ie is associated with high morbiditymortality and is most frequent on the left side of the heart.
Two major techniques are employed in tricuspid valve repair. Esc guidelines on infective endocarditis prevention, diagnosis. Bioprosthetic tricuspid valve endocarditis caused by. The triad of intravenous drug abuse, staphylococcus aureus septicemia, and pul monary embolism with or without a tricuspid regurgitation murmur can be. However, she died before surgery with possible massive pulmonary emboli. Group b streptococcus tricuspid endocarditis as a postpartum complication is even rarer. It has been suggested that candida organisms are ordinarily incapable of initiating infection on a normal valve. Large vegetation located on the tricuspid leaflets was detected by transesophageal echocardiography. Only between 516% of rsie cases require surgical intervention. Tricuspid valve endocarditis in the era of the opioid. Of a total of 205 patients, had right valve involvement, mainly the tricuspid valve.
Prosthetic valve endocarditis is a serious condition because it can result in death. The aortic valve is the commonest valve to be affected followed by aortic and mitral valves together. Even when the clinical presentation of systemic inflammation is more suggestive of a primary. A bicuspid aortic valve is the most common congenital heart lesion.
Tricuspid valve endocarditis due to capnocytophaga. Candida endocarditis of the tricuspid valve jama jama. Although the indications for surgery were the same as those for patients with aortic endocarditis, major emboli cerebral, coronary or retinal prompted surgery in 8 of 20 patients, a much higher incidence than reported for surgery in aortic valve endocarditis. This report describes a highrisk case of tricuspid valve endocarditis secondary to intravenous drug abuse. A tricuspid valve repair procedure involves working on the patients original tricuspid valve.
Valvular stenosis is an uncommon finding in bacterial endocarditis involving native cardiac valves. Using aspirationbased tricuspid valve endocarditis. At operation all of the anterior leaflet of the tricuspid valve was resected with the vegetation. To the best of our knowledge, this etiology has not been documented in the medical literature previously. Tricuspid valve endocarditis due to streptococcus bovis in. Isolated pulmonary valve endocarditis complicated with septic emboli to the lung causing pneumothorax, pneumonia, and sepsis in an intravenous drug abuser. Patients were stratified on the basis of type of tricuspid valve operation. Echocardiographic detection of tricuspid valve prolapse. One goal of the repair was to avoid implanting any.
This report details each step of complex tricuspid valve leaflet repair for tricuspid valve endocarditis, as typically performed at our institution figure 1, figure 2, figure 3, figure 4, figure 5, figure 6, figure 7, figure 8, figure 9. Group b streptococcus tricuspid endocarditis presenting. Endocarditis in persons who use injection drugs is likely to be rightsided. In our patient the development of candida tricuspid endocarditis appeared to be related to prior damage to the valve and antibiotic therapy. Indications and timing for surgery are less clear than for leftsided ie. The presentation with endocarditis is insidious, with negative blood cultures, and oftentimes it is not obvious in diagnostic imaging studies until hemodynamic changes or valve destruction is reached 1.
Isolated tricuspid valve endocarditis sciencedirect. We sought to determine the risk of ie of the bav compared with the tricuspid aortic valve tav and to determine the risk of aortic valve replacement and mortality after ie. Tricuspid valve infectious endocarditis is a very rare condition in immunocompetent patients or in those without any predisposing factors as alcoholism, intravenous drug abuse, cardiac implantable electronic devices, central venous catheters or congenital heart diseases. Rightsided endocarditis is exceptional in nondrug addict patients without previous heart disease. A 26 yo medical student was referred with severe tricuspid valve insufficiency for acute endocarditis. In 2009, she was diagnosed with culturenegative endocarditis, and a bioprosthetic tricuspid valve replacement was performed due to severe tricuspid regurgitation and symptoms of right heart failure. Tricuspid valves may also occur with two or four leaflets. Demographic and baseline characteristics were comparable across all groups, except that the valve repair group was older compared with valvectomy and replacement 46 vs 29 and 31 years, respectively.