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Introduction: Haemophilus influenzae (HI) is an exceedingly rare cause of infective endocarditis (IE)., Case Presentation/methods: We present a case of a 90-year-old female diagnosed with HI-IE involving the native tricuspid valve in the absence of traditional risk factors for right-sided endocarditis. She was treated with a 5-week course of IV Ampicillin from negative cultures and suffered no complications. We also conducted a thorough literature review through PubMed and Google Scholar, which yielded a mere 15 reported cases of HI-IE., Results: Fourteen of the reported HI-IE cases included epidemiological data, showing no gender predominance. The mean age of the subjects was 39.5, with the mitral valve being the most implicated (64%) and tricuspid valve involvement being rare (21%)., Conclusion: Native tricuspid valve IE is an uncommon entity, especially in the absence of IV drug use. Haemophilus influenzae is an extremely rare cause of IE, with a literature review showing merely 15 reported cases. This article cites the 16th case of HI-IE published in the literature., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Background: Coxiella burnetii is a bacterium with extreme tenacity and contagiousness that is mainly transmitted by inhalation of contaminated aerosols. Nevertheless, a transmission by ticks is under discussion. We report a case of Q fever in an urban environment and far away from sheep breeding that caused a rare right-sided endocarditis., Case Presentation: A 55-year-old man who was in good health before the event developed a C. burnetii -endocarditis of the tricuspid valve. He had no contact with sheep and no recent travel in a rural or even endemic area. The infection originated in a strictly urban environment, and the patient's occupation as a cemetery gardener in Berlin, coupled with the close temporal and local exposure to wild boar, made a transmission by these animals a plausible hypothesis. The infection was confirmed by the German Reference Laboratory, and the patient recovered completely after treatment with doxycycline and hydrochlorquine., Conclusions: The specialities of this case report are the right-sided endocarditis and the transmission of C. burnetii in a metropolitan area without sheep contact. We think that this case should serve to increase awareness of the potential for Q fever infection even in non-rural areas., (© 2024. The Author(s).)

SummaryWe describe a case of culture-negative infective endocarditis due to Neisseria gonorrhoeae , where the application of metagenomics shotgun sequencing in blood played a pivotal role in elucidating the underlying aetiology, guiding targeted therapy and ultimately resulting in the patient's complete recovery. Beyond its immediate clinical impact, prompt treatment bears significant implications for public health. The utilisation of molecular testing emerges as a valuable strategy to enhance diagnostic accuracy, particularly in cases involving fastidious organisms that are infrequently associated with infective endocarditis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Vancomycin-resistant enterococcal (VRE) bacteremia is associated with higher mortality rates and longer hospitalizations than vancomycin-sensitive enterococcal (VSE) bacteremia. A 67-year-old man with a right psoas abscess and pacemaker-associated tricuspid valve endocarditis in September 2020 grew VSE Enterococcus faecium from blood cultures that cleared after administration of intravenous vancomycin and gentamicin. Subsequently, he underwent tricuspid valve repair, pacemaker removal, and partial lead extraction. Valve and postoperative blood cultures grew VRE E. faecium , which cleared after administration of intravenous daptomycin. One VSE and two VRE isolates were collected and sequenced. All isolates belonged to E. faecium multilocus sequence type ST17 and were closely related, having <20 mutations in pairwise genome comparisons. Vancomycin resistance was due to the acquisition of a plasmid-encoded VanA operon. None of the isolates encoded the virulence factors asa1 , gelE , cylA , or hyl ; all encoded a homologue of efaAfm . VSE E. faecium , but not VRE E. faecium isolates, encoded a glucose transporter gene mutation. Two VRE E. faecium isolates formed more robust biofilms than the VSE E. faecium isolate ( p  < 0.001). The VRE E. faecium isolates, which generated larger biofilms than the VSE E. faecium isolate, could have remained protected in the heart valve and only caused bacteremia when disrupted during cardiac surgery. This study demonstrates that bacteria detected in the bloodstream of patients with endocarditis may not fully represent the organisms adherent to the cardiac valves or indwelling devices.

A 46-year-old male was having un-resolving fever for six weeks. Trans-esophageal echocardiography showed tricuspid valve myxoma (TVM). Kodamaea ohmeri was identified in 2 blood cultures and confirmed by 28S rDNA sequencing. Over three weeks of liposomal Amphotericin-B, fever has subsided thus indicated a clinical response. Subsequent echocardiography revealed no regression of suspected vegetation, and it was removed, and TV replacement was done. Histopathology revealed an infected myxoma and K. omeri was detected following 28S rDNA sequencing. For cardiac myxoma, excision is offered while for IE prolonged use of antifungals with or without vegetectomy is offered. So proper identification is important., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2020 Indian Association of Medical Microbiologists. Published by Elsevier B.V. All rights reserved.)

Tricuspid valve infective endocarditis is an increasingly common sequela of the opioid epidemic. While often managed medically, certain subsets of patients will require surgical intervention, including repair, replacement, and possibly even excision. Historically, simple valvectomy was performed in instances of recidivism and reinfection; however, reoperation and replacement has become the preferred treatment in the current era. Given the increasing incidence of intravenous drug use and the increase in the number of patients presenting with recurrent infections, simple valvectomy has regained favor in recent years. In this article, we present the management of a critically ill patient with recurrent tricuspid valve endocarditis who underwent tricuspid valvectomy that was complicated by a left ventricle to right atrium fistula and discuss some of the most important perioperative issues and complications for patients who undergo tricuspid valvectomy.

History and Clinical Findings:  Emergency admission of a 66-years-old man with right-sided and partly breath-dependent chest pain in the interdisciplinary emergency room. The complaints existed for several days and had a progressive character. Purulent expectoration and fever were negated. There was a history of COPD with occasional pulmonary exacerbations. Several weeks before the current event, community-acquired pneumonia had been treated with antibiotics. Moreover, the patient reported on multiple spine surgery procedures performed in recent months., Investigations and Diagnosis:  In transthoracic echocardiography (TTE), detection of a foreign body (Palacos) in the right ventricle, which was confirmed to be a toothpick-like structure in the supplementary CT scan of the thorax and the transoesophageal echocardiography (TOE)., Treatment and Course:  Foreign body extraction using right anterior mini thoracotomy. Subsequently, iatrogenic pneumothorax with bilateral nosocomial pneumonia and drainage. After short-term convalescence, renewed admission with bilateral pulmonary infiltrates. Under invasive ventilation, new left-sided pneumothorax was diagnosed, which was supplied with a Bülau drainage. Due to the detection of positive blood cultures, re-conducting of a TOE examination. Now first diagnosis of tricuspid valve endocarditis. Despite successful surgical biologic tricuspid valve replacement with an epicardial pacemaker electrode placement, the patient died approximately three quarters of a year after he became an emergency patient due to dyspnoea., Discussion:  The present case shows that a typical clinical symptom, associated with a previously known chronic illness, has to be reminded again and again of other and less common diseases. Even everyday diagnostic and therapeutic procedures are associated with a residual risk of possible complications., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Scorpion sting envenoming is a common pediatric emergency in the Moroccan southern areas. Cardiomyopathy is the most common cardiovascular manifestation of envenoming, resulting from the stimulation of the sympathetic nervous system by the venom or from the direct effect of the venom toxins on the myocardium. Rare cases of infective endocarditis following a scorpion sting have been reported in the literature. We report a case of tricuspid valve infective endocarditis following a scorpion sting in a previously healthy eight-year-old child. The patient initially was managed medically before undergoing tricuspid valve replacement with a bioprosthesis. The postoperative course was uneventful with a full recovery.

We present a case of endocarditis wherein organisms cultured from different valve leaflets yielded different daptomycin susceptibilities from each other and from organisms obtained from peripheral blood culture. Genomic analyses showed mutations in mprF, purR , and agrA Pharmacokinetic simulations showed consistent activity of daptomycin plus beta-lactam against all subpopulations. This represents an opportunity to understand S. aureus evolution and fitness in vivo on daptomycin therapy and the role of beta-lactams to prevent the selection of daptomycin-resistant subpopulations., (Copyright © 2020 American Society for Microbiology.)

Infective endocarditis is a common complication in patients using intravenous drugs. Fungal endocarditis is a rare clinical entity and diagnosis are often delayed. Only a few cases of candida dubliniensis have been reported in the literature so far. These cases usually present in patients with a history of intravenous drug abuse. If a patient with valvular endocarditis continues to have fever despite antibiotics, then fungal infection should be suspected. Fungal endocarditis is usually treated surgically along with a prolonged course of antifungal treatment. We report an interesting case of a young female who initially presented with fever and chills and was subsequently found to have a significantly large tricuspid mass. Upon further study it was found to be of fungal origin which was later confirmed by biopsy cultures., (Copyright© South Dakota State Medical Association.)

Introduction:  Surgical management for tricuspid valve (TV) endocarditis is usually TV repair or replacement. When repair is not feasible, and concerns for patient recidivism preclude TV replacement, tricuspid valvectomy without replacement is an option to alleviate symptoms and allow time for addiction management., Methods:  We reviewed our institution's experience with isolated tricuspid valvectomy for cases of intravenous drug use (IVDU)-associated endocarditis ( n  = 7) from 2009 to 2017., Results:  The decision for tricuspid valvectomy was based on each patient's comorbid condition and realization of active IVDU. This intervention resulted in 100% perioperative and mid-term survival with a mean follow-up of 25.4 months. One patient required a valve replacement in the long term only after appropriate substance abuse management was completed., Conclusion:  Cardiac surgeons increasingly encounter patients with active endocarditis who suffer from IVDU addiction. Drug addiction increases the risk for recurrent endocarditis and requires an effective management plan. Multidisciplinary endocarditis care teams may play a pivotal role in improving outcomes by better addressing addiction treatment., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

A 57-year-old man presented for an elective pacemaker upgrade, complicated by the discovery of device infection. He had a background of complex congenital heart disease, including replacement of heart valves, and was treated for presumed infective endocarditis that was later confirmed by echocardiography. Antibiotic treatment, with intravenous vancomycin, was given as per the tissue sample sensitivities. On day 24 of treatment he deteriorated clinically, with the evolution of recurrent fever, epigastric pain, diarrhoea, widespread pruritic rash, lymphadenopathy and severe hypoxia over the subsequent 7-10 days. Blood tests revealed development of a marked eosinophilia, transaminitis and rising inflammatory markers. Further radiological imaging was non-diagnostic. On the basis of these clinical and biochemical features a diagnosis of drug reaction with eosinophilia and systemic symptoms syndrome was made. This led to the cessation of vancomycin, the offending agent and the referral for specialist immunology advice. He was subsequently treated with oral prednisolone and made a full recovery., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: A case report of the use of linezolid and daptomycin for the treatment of multidrug-resistant right-sided infective endocarditis is presented., Summary: A 36-year-old patient with a history of intravenous drug use was hospitalized for treatment of native tricuspid valve endocarditis resulting in persistent methicillin-resistant Staphylococcus aureus bacteremia. During the admission the patient was unsuccessfully treated with vancomycin monotherapy (final E-test minimum inhibitory concentration, 4 μg/mL). The patient's treatment was switched to daptomycin and gentamicin, with no improvement in blood culture results over 4 days. Gentamicin was discontinued, and linezolid was administered in combination with daptomycin; bacteremia was cleared after 13 days of linezolid and daptomycin combination therapy. Due to daptomycin resistance (minimum inhibitory concentration, 4 μg/mL), gentamicin was substituted for daptomycin due to the former agent's synergistic effects with linezolid. After 23 days of therapy the patient was transferred to another facility for a tricuspid valve replacement procedure, which was completed without complications. The patient was transferred in stable condition to a skilled nursing facility to continue antibiotic therapy lasting 6 weeks from the date of surgery. The patient's blood cultures remained negative., Conclusion: A 36-year-old woman with resistant tricuspid valve endocarditis was successfully treated with linezolid in combination with daptomycin., (© American Society of Health-System Pharmacists 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Coronary artery stent infection with mycotic aneurysm is a rare life-threatening complication following coronary angioplasty, usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe an unusual case of bare metal stent infection and coronary artery aneurysm in the setting of tricuspid valve infective endocarditis, resulting in ST elevation myocardial infarction, with a favorable outcome after primary angioplasty and antibiotic therapy. In the current era of growth of coronary stent implantation, it's important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although treatment modalities tend to favor surgery, we showed that coronary angioplasty could be a successful alternative solution., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Ben Messaoud M et al.)

Polyamines are small aliphatic cationic molecules synthesized via a highly regulated pathway and involved in general molecular and cellular phenomena. Both mammalian cells and microorganisms synthesize polyamines, and both sources may contribute to the presence of polyamines in the circulation. The dominant location for microorganisms within the body is the gut. Accordingly, the gut microbiota probably synthesizes most of the polyamines in the circulation in addition to those produced by the mammalian host cells. Polyamines are mandatory for cellular growth and proliferation. Established evidence suggests that the polyamine spermidine prolongs lifespan and improves cardiovascular health in animal models and humans through both local mechanisms, involving improved cardiomyocyte function, and systemic mechanisms, including increased NO bioavailability and reduced systemic inflammation. Higher levels of polyamines have been detected in non-dilated aorta of patients affected by bicuspid aortic valve congenital malformation, an aortopathy associated with an increased risk for thoracic ascending aorta aneurysm. In this review, we discuss metabolism of polyamines and their potential effects on vascular smooth muscle and endothelial cell function in vascular pathology of the thoracic ascending aorta associated with bicuspid or tricuspid aortic valve., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Simultaneous left and right-sided native valve infective endocarditis (IE) is rare. Staphylococcus aureus was the predominant organism for bilateral IE. Shunt diseases are common risk factors of both-sided IE. Streptococcus anginosus (S. anginosus) is usually associated with pyogenic infections, but rarely a cause of IE. Here we present an extremely rare case of simultaneous left and right-sided native valve IE affecting the mitral and tricuspid valves caused by S. anginosus in an adult patient that has not been reported in the literature previously, particularly without the most frequent predisposing factors of IE. A 66-year-old man was admitted due to generalized fatigue, chills, malaise, and intermittent fevers for 1 year. A grade III-IV/VI systolic murmur at the mitral area and a III/VI systolic murmur at the tricuspid area were noted on physical examination. Laboratory evaluation revealed an elevated erythrocyte sedimentation rate and C-reactive protein level, and high fasting blood glucose. Blood culture was positive for S. anginosus. Echocardiography revealed vegetations in both sides of the heart: a large mitral valve vegetation with severe mitral regurgitation, as well as another vegetation on the tricuspid valve with moderate regurgitation. The case highlights a rare pathogen of both-sided IE, a rare presentation of S. anginosus infection, and several points worthy of note in echocardiography of IE.

Competing Interests: Competing interests: None declared.

Infective endocarditis is a high morbidity-mortality condition despite advancements in supportive care and medical therapy. One of the strongest risk factors is intravenous drug use, which has high prevalence in the Hawai'i population. Klebsiella pneumoniae is a rare but aggressive pathogen causing infective endocarditis. There is no strong evidence to guide management. We present a rare case of isolated tricuspid valve infective endocarditis due to Klebsiella pneumoniae in an intravenous drug user causing septic pulmonary emboli and multiple abscesses. The patient was managed with combined 6-week ceftriaxone and 2-week gentamicin together with early tricuspid valve repair., Competing Interests: None of the authors identify a conflict of interest.

Background: Only 4.1% of tricuspid valve IE cases require surgical intervention. The complication after tricuspid valve IE with lung abscess and empyema is rare., Case Presentation: We report the case of a 38-year-old male (an intravenous drug abuser) diagnosed with tricuspid valve IE who underwent tricuspid valve replacement. The case was complicated by multiple lung abscesses and thoracic empyema. The pathogens causing the lung abscesses and empyema were Acinetobacter baumannii complex and Candida albicans, which were different from those causing the endocarditis. After 4 weeks of antibiotic treatment, chest X-ray revealed bilateral clear lung markings with only mild blunting of the right costophrenic angle., Conclusion: The pathogen causing the lung abscess is not always compatible with that causing the endocarditis. Thoracoscopic incision of the abscess with 4 to 6 weeks of broad-spectrum antibiotic treatment is effective and safe.

BACKGROUND Right-sided infective endocarditis is a classic complication of intravenous drug abuse. Without timely bactericidal antibiotics, the disease process can progress to septic pulmonary emboli. Rarely, a pneumothorax can occur as a result of the emboli, and progressive persistent valvular disease may require a valve replacement. Tricuspid valve replacement has a high morbidity rate even in stable patients. CASE REPORT We present a case of tricuspid valve replacement in a 39-year-old man with peripheral intravenous drug abuse who had bilateral pneumothoraces secondary to septic pulmonary emboli originating on large tricuspid valve infected vegetations. The patient died 21 days after the valve replacement. CONCLUSIONS Tricuspid valve replacement is an especially dangerous procedure in intravenous drug abusers who present with bilateral pneumothoraces and advanced cardiopulmonary pathology.

Background: Burkholderia is a pathogen that is rarely seen in clinical cases. However, this organism is being found more commonly in hospitals., Case Presentation: A female Indonesian newborn was referred to our neonatal intensive care unit because of respiratory distress. The newborn had been delivered the previous night via cesarean section. A physical examination revealed intercostal retractions and weak cry. The newborn's gestational history was preterm, small for gestational age, and preterm premature ruptured membrane for 14 hours. Continuous positive airway pressure was administered. A multiple-antibiotic regimen consisting of ampicillin-sulbactam, gentamicin, meropenem, and ceftriaxone was initiated. Insertion of a central catheter was performed. The patient's laboratory results were low blood albumin and globulin, anemia, and leukopenia. A blood culture revealed Burkholderia cepacia that was resistant to multiple antimicrobial agents. A chest x-ray showed infiltrate on both lung fields. Echocardiography showed two vegetations on the tricuspid valve., Conclusions: B. cepacia is a rare cause of infective endocarditis. With its capability to colonize water and grow on microbicides, the presence of B. cepacia in a patient's blood warrants further investigation in institutions providing care. This might not be the first publication on this topic.

The use is reported of the AngioVac system to resolve a case of persistent bacteremia in the setting of MRSA tricuspid valve infective endocarditis. The infection was secondary to intravenous drug use in a patient who had failed multiple antibiotic regimens and was deemed a poor surgical candidate.

Both KBG syndrome (approximately 50 patients worldwide) and isolated tricuspid valve Staphylococcus lugdunensis endocarditis are very rare entities. The KBG syndrome is a multiple congenital anomaly characterized by short stature, distinctive craniofacial features, and neurologic/developmental/cognitive delay and is only associated to congenital heart defects in 9% of patients. Staphylococcus lugdunesis is an aggressive cause of infective endocarditis. Herein is described a case of a patient presenting both diseases, despite the absence of any known infection, congenital heart defect, heart device or any other entry port which could explain this scenario. The unusual findings in this young patient raised questions regarding the, as-yet unexplained, etiopathogenesis of the KBG syndrome, the possibility of it being related to this rare and concerning clinical presentation and the unclear and undefined management and surgical approach associated to right side endocarditis.

Objective: The rarity of invasiveness of right-sided infective endocarditis (IE) compared with left-sided has not been well recognized and evaluated. Thus, we compared invasiveness of right- versus left-sided IE in surgically treated patients., Patients and Methods: From January 2002 to January 2015, 1292 patients underwent surgery for active IE, 138 right-sided and 1224 left-sided. Among patients with right-sided IE, 131 had tricuspid and 7 pulmonary valve IE; 12% had prosthetic valve endocarditis. Endocarditis-related invasiveness was based on echocardiographic and operative findings., Results: Invasive disease was rare on the right side, occurring in 1 patient (0.72%; 95% confidence interval 0.02%-4.0%); rather, it was limited to valve cusps/leaflets or was superficial. In contrast, IE was invasive in 408 of 633 patients with aortic valve (AV) IE (65%), 113 of 369 with mitral valve (MV) IE (31%), and 148 of 222 with AV and MV IE (67%). Staphylococcus aureus was a more predominant organism in right-sided than left-sided IE (right 40%, AV 19%, MV 29%), yet invasion was observed almost exclusively on the left side of the heart, which was more common and more severe with AV than MV IE and more common with prosthetic valve endocarditis than native valve IE., Conclusions: Rarity of right-sided invasion even when caused by S aureus suggests that invasion and development of cavities/"abscesses" in patients with IE may be driven more by chamber pressure than organism, along with other reported host-microbial interactions. The lesser invasiveness of MV compared with AV IE suggests a similar mechanism: decompression of MV annulus invasion site(s) toward the left atrium., (Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background  The aim of this study was to evaluate the perioperative characteristics and the short- and mid-term outcomes in patients undergoing tricuspid valve (TV) surgery for isolated TV endocarditis. Patients and Methods  A total of 56 patients with isolated TV endocarditis underwent TV surgery at a single center between June 1995 and February 2012. Mean age of patients was 53.8 ± 17.1 years, 39 (69.6%) being male. The mean left ventricular ejection fraction was 60.4 ± 13.6% and 13 (23.2%) patients had diabetes mellitus. Average logistic EuroSCORE was 19.4 ± 17.0%. Mean follow-up was 4.7 ± 3.8 years. Results  Microbiological investigations revealed positive blood cultures in 89.1% of patients and positive intraoperative swabs in 51.9%. The most common pathogen (42.9%) isolated was Staphylococcus aureus , followed by coagulase-negative staphylococcus (17.9%). Discussion  A history of intravenous drug abuse (IVDA) was recorded in 11 patients (19.6%), of which 8 patients additionally had hepatitis C. A total of 15 patients (26.8%) had a permanent pacemaker/implantable cardioverter-defibrillator in situ. TV replacement was performed in 22 patients (39.3%) and TV repair was performed in 34 patients (60.7%). Overall 30-day mortality was 12.5%. Five-year survival was 63.9 ± 7.2% (95% confidence interval [CI]: 64.0-137.5 months). Freedom from reoperation for recurrent TV endocarditis was 91.7 ± 4.0% (95% CI: 152.3-179.3 months) at 5 years. Conclusion  Blood culture is the most important tool to detect the causative pathogen causing IE of TV. The high risk of hepatitis C in patients with IVDA and IE of the TV should be mentioned., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Tricuspid valve surgery has been the de facto standard treatment for tricuspid valve endocarditis (TVE) refractory to medical therapy. It is now possible to remove right-sided vegetations percutaneously using a venous drainage cannula with an extracorporeal bypass circuit., Objectives: The purpose of our study is to describe our single-center experience of percutaneous tricuspid valve vegetation removal., Methods: We reviewed the perioperative course of 33 consecutive patients with large tricuspid valve vegetations who carried high surgical risk., Results: The cohort included 12 males and 21 females over a 40-month period with an average age of 37 years. A preponderance of patients carried an admitted or confirmed diagnosis of injection drug use (72.7%). Average vegetation size was 2.1 +/- 0.7 cm prior to the procedure with a 61% reduction in size after the procedure. All patients survived the procedure and 90.9% survived the index hospitalization. Three patients proceeded to elective tricuspid valve replacement due to worsening severity of tricuspid regurgitation., Conclusion: Percutaneous removal of large tricuspid valve vegetations is a safe and effective alternative for patients with TVE who carry high-surgical risk. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Background: The involvement of atrial embryonic remnants in infective endocarditis (IE) has seldom been reported. The study aim was to evaluate the prevalence of vegetations on right atrial embryonic remnants (RAER) in patients with a definitive diagnosis of IE., Methods: Since 1998, all consecutive patients with suspected IE were referred to the authors' institution to undergo transesophageal echocardiography (TEE). Patients with a high probability of IE but with a negative result underwent a further TEE examination within 10 days. The involvement of RAER was investigated systematically., Results: Among a total of 585 patients evaluated, definitive criteria for IE were present in 210 (35.9%). Right-sided IE was detected in 33 patients (15%); these included 21 infections on the tricuspid valve (65%), 10 cases of intracardiac electronic device infection (29%), one infection on the Thebesian valve (3%), and one on the pulmonary valve (3%). The incidence of right-sided IE was 0.84 per 100,000 population per year. RAER involvement was detected in five patients (15% of right-sided endocarditis), representing 2.5% of the complete IE series. The incidence of RAER endocarditis was 0.13 new cases per 100,000 population per year. The Eustachian and Thebesian valves were involved in four cases. Two patients presented with pulmonary embolism and died in hospital. Transthoracic echocardiography (TTE) allowed the detection of RAER vegetations in two cases., Conclusions: Although the prevalence of embryonic remnants involvement in IE is underestimated, it may carry an important embolic risk if undetected. As TTE demonstrated only a low sensitivity in the diagnosis of embryonic remnant involvement, TEE should be performed systematically and RAER involvement carefully sought. TEE is recommended in all patients with a high clinical suspicion of right-sided IE. Video 1: Mid-esophageal TEE view. Multiple vegetations attached onto the pacemaker leads (broken arrow) and on the Eustachian valve (solid arrow). Video 2: Mid-esophageal TEE view. A vegetation attached onto the tricuspid valve (broken arrow) and on the Eustachian valve (solid arrow).

Background: Tricuspid valve infective endocarditis (TVIE) causes septic pulmonary embolism (PE). However, the impact of vegetation size on PE is not fully elucidated., Methods: In 26 consecutive patients with definite TVIE according to Duke criteria, we tested clinical, microbiological, and echocardiographic data including real time three-dimensional transesophageal echocardiography (3DTEE) as potential predictors of PE. 3DTEE measurement of maximum length of vegetation (MLV) was obtained with Advanced QLAB Quantification Software by cropping the 3D volume with the appropriate 2D plane to obtain the largest value. The standard two-dimensional transesophageal echocardiography (2DTEE) images were also evaluated to determine the MLV., Results: Pulmonary embolism occurred after TVIE diagnosis with 3DTEE assessment and initiation of antibiotic therapy in 12 patients (46.2%). The 3DTEE MLV was larger than the 2DTEE value with a mean difference of 3.6 mm (95% CI, 2.5-4.6 mm). The best cutoff value for prediction of PE was MLV ≥16.4 mm with 3DTEE and MLV ≥9.5 mm with 2DTEE. The positive predictive value increased from 76.9% to 90% when 3DTEE was used. The accuracy of classification of patients with PE increased from 80.6% to 84.9% with 3DTEE. On multivariate analysis, 3DTEE MLV ≥16.4 mm (odds ratio 20.5; 95% confidence interval 1.31-322; P=.031) was independently associated with the occurrence of PE after adjustment for age, sex, complex vegetation, and the number of vegetation-attached leaflets., Conclusions: In TVIE, vegetation length is a strong predictor of the occurrence of PE. In combination with 2DTEE, 3DTEE may identify high-risk patients who will need a more aggressive therapeutic strategy., (© 2017, Wiley Periodicals, Inc.)

Infective endocarditis of the tricuspid valve (TVE) occurs predominantly in selected groups of patients including intravenous drug users (IVDUs). The most often cultured pathogen in IVDUs is Staphylococcus aureus. Eikenella corrodens, normally existing as a commensal in the mouth and the upper respiratory tract, is identified as an etiologic pathogen of endocarditis very rarely. The authors describe a case of a 27-year-old male with a past history of staphylococcal TVE readmitted to hospital after 5 months due to progression of right-sided heart failure. Bacteriological work-up revealed typical features and growth of E. corrodens. In echocardiography large vegetations on the damaged tricuspid valve and massive tricuspid regurgitation were seen. The prognosis of the disease, despite introduction of appropriate antibiotic therapy, was poor as he refused to undergo cardiac surgery.

Infectious endocarditis due to Cardiobacterium hominis is an uncommon event, accounting for less than 2% of all cases of infectious endocarditis. The infection of the tricuspid valve as it is reported here is extremely rare. We report the case of a tricuspid endocarditis due to Cardiobacterium hominis in a 56 year-old man who was admitted to hospital with pelvic and scapular pain. The diagnosis was established through positive blood cultures and echographic detection of a large tricuspid vegetation. Despite efficient antibiotic therapy, valve replacement was required. The clinical course of Cardiobacterium endocarditis is usually subacute, and the diagnosis may therefore be delayed. This case emphasizes the shift between the poverty of clinical symptoms and severity of cardiac damages, what we could call the Cardiobacterium paradox.