Tricuspid Valve Infective Endocarditis

Abstract

The tricuspid valve, which has been known as the “forgotten valve”, must not be ignored in infective endocarditis. Tricuspid valve infective endocarditis is a very complex condition and occurs in a complex patient population. The causative organisms are often highly virulent and patients usually have a history of intravenous drug abuse. Although the success rate of antibiotic therapy is high, certain features or complications may require surgery. Understanding the therapeutic options, the challenges of surgical intervention and the components of the patient-centered longitudinal care plan is crucial in order to minimize the risk of relapse, which is unfortunately not uncommon in these patients.

Complexities of Infective Endocarditis in a Young Patient With Hypertrophic Obstructive Cardiomyopathy: A Case of Dual Valve Involvement and Neurological Complications

“…The major criteria consist of positive blood cultures for infective endocarditis and evidence of endocardial involvement confirmed by echocardiogram [5]. Minor criteria include predisposition, such as a predisposing heart condition or intravenous drug use; fever; vascular phenomena such as major arterial emboli, septic pulmonary infarcts, or mycotic aneurysm; immunologic phenomena such as glomerulonephritis, Osler's nodes, Roth's spots, or rheumatoid factor; microbiological evidence not meeting the major criteria; and echocardiographic findings consistent with infective endocarditis, but not meeting the major criteria [5]. A diagnosis can be made when specific combinations of these criteria are met: either two major, one major and three minor, or five minor [5].…”

“…Minor criteria include predisposition, such as a predisposing heart condition or intravenous drug use; fever; vascular phenomena such as major arterial emboli, septic pulmonary infarcts, or mycotic aneurysm; immunologic phenomena such as glomerulonephritis, Osler's nodes, Roth's spots, or rheumatoid factor; microbiological evidence not meeting the major criteria; and echocardiographic findings consistent with infective endocarditis, but not meeting the major criteria [5]. A diagnosis can be made when specific combinations of these criteria are met: either two major, one major and three minor, or five minor [5]. Antibiotics directed against the causative agent are the mainstay of treatment of IE in patients with concurrent HOCM; surgery should be considered when there are traditional indications such as abscess, significant hemodynamic compromise, or embolization [4].…”

Severe Tricuspid Regurgitation in a Patient With Previous Tricuspid Valve Surgery for Infective Endocarditis Secondary to Intravenous Drug Use: A Case Report

“…The foundation of IE diagnosis is blood cultures and echocardiography. A transthoracic echocardiogram (TTE) must be done initially, but in the majority of cases of suspected or confirmed IE, both TTE and TEE should be done [7,8]. Choosing the best therapeutic approach requires careful consideration of the prognostic assessment upon admission.…”

“…The leading bacterial cause of infective endocarditis (IE) is Staphylococcus aureus, followed by Streptococcus viridans, with rare presentations by Staphylococcus epidermidis, Streptococcus bovis, and Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species (HACEK) organisms [6]. There are certain aspects of TVIE that can make its detection difficult, such as the absence of murmur, concurrent pneumonia, and less prominent peripheral signs, including splinter hemorrhage, Osler nodes, and Janeway lesions [7]. RSIE and TVIE are increasing in prevalence, and antibiotics and surgical options remain a cornerstone of successful treatment.…”