Tricuspid Valve Infective Endocarditis in a 24 Years Old Patient with Ventricular Septal Defect

Abstract

Congenital heart disease is a well-known lifelong risk factor for infective endocarditis. Tricuspid valve involvement is mostly seen in ventricular septal defects, often complicated by pulmonary embolism.

A 24-years old male was admitted to our emergency department presenting with fatigue, dyspnea, and persistent fever. His medical background included some type of congenital heart defect (undefined from the family), urinary tract infections with repetitive fever in the past 6 months.Upon arrival in the emergency room, physical examination revealed temperature 38°C, regular but tachycardic (120 beats per minute) rhythm, 3/6 holosystolic murmur in the third left intercostal space. Laboratory tests showed severe anaemia (Hb 5 g/l) increasing of WB (white blood cells),C-reactive protein (CPR) and elevated serum urea and creatinine (6 mg/dl). According to patient’s clinical history test results, she was referred to nephrology ward for further investigations.

A transthoracic echocardiography demonstrated the presence of a small (7 mm) peri-membranous ventricular septal defect, severe tricuspid regurgitation with rupture of the septal leaflet and the presence of the vegetations on the ventricular side of the valve (large mass 20x 13 mm with irregular margins) attached to the septal leaflet. The heart was enlarged with biventricular dilatation and elevated pulmonary pressures. After a suspicion of infective endocarditis of the right side of the heart, the patient was treated with antibiotic triple therapy for a period of two weeks and after improvement in the renal and haemoglobin levels he underwent cardiac surgery. The ventricular defect was closed with autologous pericardial patch and tricuspid complex valvuloplasty was real success of the operation.

Postoperative recovery was uneventful and the patient left the hospital in good conditions ten days after surgery. He received antibiotics for another three weeks and on control laboratory data were normal except a slightly elevated serum creatinine. The tricuspid valve had minimal regurgitation and no residual septal defect was detected on echocardiography.

Even nowadays in the era of modern medicine, we should forget an unfollowed congenital heart disease as a predisposing condition for infective endocarditis. A multi-disciplinary team is effective in treating this complex pathology and achieve good results. We had a successful treatment of this patient especially in terms of surgery where we realised a good tricuspid valve repair.