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A pulmonary artery catheter removed from a man with idiopathic cardiomyopathy yielded Staphylococcus aureus in culture, as did blood and sputum. Septic endocarditis of the right side of the heart was found at autopsy. A review of 438 autopsy reports in which an indwelling pulmonary catheter had been used and of another 493 reports preceding its use at our medical center suggests no association between the use of indwelling catheters in the right side of the heart and endocarditis in the left, although there is a risk of thrombotic endocardial vegetation formation in the right side of the heart, with possible infection or embolization.

Enterococci caused eleven of 20 cases (55%) of narcotic-associated endocarditis in Cleveland over a 54-month period. Acute staphylococcal endocarditis seen concurrently in this addict population displayed tricuspid valve involvement and septic pulmonary emboli, but enterococcal endocarditis was subacute, affected only aortic or mitral valves, and was not associated with septic pulmonary emboli. In contrast to enterococcal endocarditis in a nonaddict population, patients were younger and rarely had antecedent valvular disease or genitourinary abnormality. Staphylococcal tricuspid valve endocarditis was managed with relatively little difficulty in this addict population. Enterococcal infection, however, was complicated by severe cardiac failure that often required valvular prostheses, relapses due to continued use of narcotics, Candida superinfection, and nervous system complications, including cerebral emboli and mycotic aneurysms.

To assess the incidence of aseptic thrombotic endocardial vegetations (TEV) after pulmonary artery catheterization with Swan-Ganz catheters we reviewed all autopsy reports for a two-year period in our hospital. In 413 autopsies there were five instances of aseptic TEV: 3 in 88 patients with Swan-Ganz catheters, 1 in 120 patients with central venous catheters, and 1 in the 205 patients without central vascular catheters. The incidence of TEV is significantly greater in patients with Swan-Ganz catheters than in other patients.