OP-118 [AJC » Diagnosis and Treatment of Valvular Hearth Disease] Giant Tricuspid Valve Endocarditis

A 24 year old man was admitted to our emergency department with severe dyspnea and fever. He was smoker and intravenous drug abuser. On admission; his blood pressure was hypotensive (96/52 mmHg) and heart rate was 132 bpm. His oxygen saturation was 88 % with oxygen mask. He was tachypneic, febrile with elevated juguler venous pressure, and a prominent V wave. There was a grade 3/6 pansystolic murmur over the left sternal border. Electrocardiogram (ECG) showed sinus tachycardia. Patient was admitted to coronary care unit. A two-dimensional echocardiography revealed dilated right atrium (RA) and right ventricle (RV) with a giant, oscillating vegetation attached to the tricuspid valve (Panel A, B), which severe tricuspid regurgitation in systole (Panel C). A transesophageal echocardiography showed giant tricuspid vegetation which was 27 mm X 32 mm in size, with an irregular contour (Panel D, E). Four sets of blood culture were positive for methicillin-sensitive Staphylococcus aureus. He was treated with intravenous flucloxacillin for one week. After a week of antibiotherapy, he was febrile and clinically unstable because of this, operation decision was made. He underwent tricuspid valve replacement using bioprosthetic valve with successful recovery (Panel F). After the operation, antibiotic treatment continued for 6 weeks and the patient was discharged successfully.