Kosin Med J.  2015 Jun;30(1):81-85. 10.7180/kmj.2015.30.1.81.

Tricuspid and pulmonary valve endocarditis associated with double-chambered right ventricle

• Myeong JC
• Chin JY
• Choi JH
• Rah YM
• Park JH

• KMID: 2308541
• DOI: http://doi.org/10.7180/kmj.2015.30.1.81

Abstract

We report a rare case of tricuspid valve and pulmonary valve endocarditis associated with a double-chambered right ventricle in an adult female with pulmonary artery aneurysm and septic pulmonary embolism by Streptococcus mitis. She was treated with aggressive antibiotic therapy followed by debridement of the infective lesion of tricuspid valve, pulmonary valve replacement using xenograft and resection of obstructing muscular bundles in right ventricle.

Keyword

Bacterial endocarditis; Congenital heart disease; Pulmonary valve; Right ventricle; Tricuspid valve

MeSH Terms

Adult
Aneurysm
Debridement
Endocarditis*
Endocarditis, Bacterial
Female
Heart Defects, Congenital
Heart Ventricles*
Heterografts
Humans
Pulmonary Artery
Pulmonary Embolism
Pulmonary Valve*
Streptococcus mitis
Tricuspid Valve

Figure

• 

  Figure 1. Initial electrocardiogram showing right ventricular hypertrophy with strain pattern, right axis deviation, and right atrial enlargement.

• 

  Figure 2. Pulmonary angio CT showing mild cardiomegaly with right heart enlargement and multiple distal pulmonary infarction (white arrow heads) with multiple pulmonary artery aneurysm (white arrows).

• 

  Figure 3. Transthoracic echocardiogram showing (A) continuous-wave Doppler tracing along the right ventricular outflow tract with peak gradient of 87 mmHg across the subinfundibulum (B) hypertrophied muscular bands dividing the right ventricle (white arrow) with D-shaped interventricular septum and large vegetation on pulmonary valve. LV: left ventricle, PV: pulmonary valve, RV: right ventricle.

• 

  Figure 4. Transesophageal echocardiogram showing echogenic shaggy materials (white arrow) on hypertrophied muscular bands, suspicious vegetations.

Reference

References

1. Hoffman P, Wójcik AW, Rózan ′ski J, Siudalska H, Jakubowska E, Włodarska EK, et al. The role of echocardiography in diagnosing double chambered right ventricle in adults. Heart. 2004; 90:789–93.

2. López-Pardo F, Aguilera A, Villa M, Granado C, Campos A, Cisneros JM. Double-chambered right ventricle associated with mural and pulmonic valve endocarditis: description of a clinical case and review of the literature. Echocardiography. 2004; 21:171–3.

3. Telagh R, Alexi-Meskishvili V, Hetzer R, Lange PE, Berger F, Abdul-Khaliq H. Initial clinical manifestations and mid- and longterm results after surgical repair of double-chambered right ventricle in children and adults. Cardiol Young. 2008; 18:268–74.

4. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. ESC Committee for Practice Guidelines.: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur. Heart J. 2009; 30:2369–413.

5. Choi YJ, Park SW. Characteristics of double-chambered right ventricle in adult patients. Korean J Intern Med. 2010; 25:147–53.

6. Simpson Jr WF, Sade RM, Crawford FA, Taylor AB, Fyfe DA. Double chambered right ventricle. Ann Thorac Surg. 1987; 44:7–10.

7. Chaurasia AS, Nawale JM, Yemul MA. Double-Chambered Right Ventricle with Pulmonary Valve Endocarditis. Echocardiography. 2013; 30:167–70.