Tricuspid Endocarditis in an Adult Patient with Ebstein’s Anomaly who has a Residual Pacemaker Lead

Abstract

Ebstein's anomaly is defined as an apical displacement of the attachment of the septal tricuspid valve leaflet from the right atrioventricular annulus that exceeded 1.2 cm in length. Patients with Ebstein's anomaly are known to have a high potential for developing arrhythmia, in the vast majority, of the tachycardia type. Infective endocarditis is characterized by ulcerovegetational lesions that result from the graft of a microorganism, usually bacterial, on the valvuler endocardium (native valve endocarditis) or on a prosthesis (prosthetic valve endocarditis). Ebstein's anomaly with tricuspid regurgitation is also thought to be a predisposing condition for infective endocarditis. In this case, we report a patient who presented with atrial flutter and infective endocarditis due to residual pacemaker lead and Ebstein's anomaly.

A Rare Manifestation of Asymptomatic Ebstein’s Anomaly with Tricuspid Valve Endocarditis

“…This is a rare case of an adult who presented with asymptomatic Ebstein's anomaly. To our knowledge, this represents the fifth reported case of a new diagnosis of Ebstein's anomaly in the setting of endocarditis and the second case of Ebstein's anomaly and endocarditis in an intravenous drug abuser [ 2 , 4 , 5 ]. The other case of Ebstein's anomaly and endocarditis in an intravenous drug abuser was in a 19-year-old patient who presented much younger than our patient [ 4 ].…”

“…The other case of Ebstein's anomaly and endocarditis in an intravenous drug abuser was in a 19-year-old patient who presented much younger than our patient [ 4 ]. The other two cases were pacemaker endocarditis [ 2 , 6 ]. Our patient presented with endocarditis secondary to intravenous drug abuse, and Ebstein's anomaly was an incidental finding on transthoracic echocardiogram.…”

“…Two-dimensional transthoracic echocardiography is the diagnostic test of choice for Ebstein's anomaly. Typical findings include apical displacement of the proximal attachment of the septal and posterior tricuspid valve leaflets greater than 8 mm/m 2 body surface area or 1.2 cm in length, redundancy and fenestrations of the anterior tricuspid valve leaflet, and dilation of the anatomic tricuspid valve annulus at the atrioventricular junction [ 2 , 3 , 7 ]. These findings will cause decreased function of the right ventricle, dilation of the right atrium, and dilation of the right ventricle in addition to atrial and ventricular arrhythmias [ 8 ].…”

“…It has a wide spectrum of clinical presentations and has been shown to manifest itself any time from birth to adulthood. When it presents in adulthood, it will typically present with symptomatic arrhythmia, usually tachycardia, or right or left sided heart failure [ 2 ].…”

“…It has been thought that Ebstein's anomaly with tricuspid regurgitation can predispose a person to tricuspid valve endocarditis, but very few cases in the literature have shown this. Rarely will Ebstein's anomaly remain undetected into late adulthood and present as an incidental finding [ 2 ].…”