Total resection and complete reconstruction of the tricuspid valve in acute infective endocarditis

摘要

Acute infective endocarditis of the tricuspid valve (TV) in noncompliant intravenous drug abusers presents a difficult problem. Progressive sepsis despite appropriate antibiotics necessitates surgical intervention. These noncompliant patients, however, often leave the hospital against medical advice. The risk of prosthetic endocarditis in this group of patients is very high. Complete resection of the valve without replacement, although feasible, can result in progressive right-sided heart failure. Reconstruction of the TV might be an alternative option.A 33-year-old man with a long history of intravenous drug abuse was admitted with fever and chills. He previously underwent drainage of an infected left hip joint, as well as multiple bilateral groin abscesses at the site of drug injection. Multiple blood cultures demonstrated Staphylococcus aureus. Despite appropriate antibiotic coverage, uncontrolled sepsis developed. Echocardiography analysis demonstrated large multiple vegetations of the TV (Figure 1, A) and an abscess extending into the free wall of the right ventricle. This infective process involved all 3 leaflets, causing TV stenosis (Figure 1, C). The patient underwent urgent surgical intervention. Total resection of the TV and the entire subvalvular apparatus was performed. The right ventricular abscess was drained. The entire operation was performed on the beating heart with cardiopulmonary bypass.