Abstract 10157: A Rare Case of Triple-Valve Endocarditis Managed Surgically

Abstract

Introduction: Triple-valve endocarditis is an extremely rare condition associated with poor prognosis and limited guidelines regarding its management. We report the unique case of a patient diagnosed with triple-valve endocarditis who underwent successful surgical intervention of all three valves. Case: A 79-year-old male with a history of benign prostatic hyperplasia requiring chronic indwelling urinary catheter presented with progressive dyspnea, lower extremity edema, and fevers. Physical exam was remarkable for a new holosystolic murmur at his right upper sternal border and jugular vein distention. Chest radiograph was consistent with pulmonary edema and cardiomegaly. A transthoracic echocardiogram revealed a large vegetation on his aortic valve with severe aortic regurgitation, moderate mitral and tricuspid valve regurgitation, and normal ejection fraction. Blood and urine cultures grew Enterococcus faecalis and Enterococcus avium , respectively. A transesophageal echocardiogram showed multiple mobile vegetations attached to his aortic valve, and small vegetations involving his mitral and tricuspid valve (Figure 1). He subsequently underwent surgical aortic valve replacement (23-mm Edwards), mitral valve replacement (27-mm Edwards), and repair of the tricuspid valve septal leaflet after excision of a 3 mm vegetation. He was discharged on ceftriaxone and ampicillin to complete 6 weeks of therapy. During his follow up visit 2 months after surgery, patient was feeling well and engaging in physical therapy. Discussion: There is a limited number triple-valve endocarditis by E. Faecalis in the current literature, and this is the first report of a patient successfully managed with three-valve surgery in this setting. We highlight the importance of early recognition and prompt surgical intervention to achieve favorable outcomes in this population.