​​​Pulmonary and Tricuspid Valve Endocarditis: A Late Sequelae of Unrepaired Double Chambered Right Ventricle in an Adult

Infective endocarditis (IE) is defined as an infection of the endocardium, most frequently involving the cardiac valves. This condition is associated with high morbidity and mortality, as well as considerable surgical complexity, despite advances in diagnostic and therapeutic strategies. Individuals with congenital heart disease are at significantly higher risk for IE compared to the general population, particularly those with ventricular septal defect (VSD). Adult cohort studies of unrepaired VSD report incidence rates of 1.7 to 2.7 per 1,000 patient-years, representing a 20- to 30-fold increased risk relative to individuals without congenital heart disease. 

VSD occupies a central role in the context of IE and congenital heart disease, due to its prevalence and its unique pathophysiological mechanisms. The high-velocity jet traversing the septal defect results in endocardial injury, facilitating bacterial adherence and subsequent vegetation formation. Clinically, this may manifest as right-sided IE involving the tricuspid valve in five percent to 10 percent of cases, or as left-sided endocarditis when the VSD is of the perimembranous or “outlet” type, due to its proximity to the aortic valvular apparatus. 

While surgical or percutaneous closure of the defect reduces the risk of IE, it does not abolish it entirely; cases have been reported following both closure methods. Registry data demonstrate a lower postoperative IE incidence compared to unoperated patients, supporting individualized consideration of defect closure based on operative risk and anatomical features. 

This video presents a case of tricuspid and pulmonary valve endocarditis in a patient with perimembranous VSD and right ventricular outflow tract obstruction (RVOTO).  

References

1. Snygg-Martin U, Giang KW, Dellborg M, Robertson J, Mandalenakis Z. Cumulative incidence of infective endocarditis in patients with congenital heart disease: a nationwide, case-control study over nine decades. Clin Infect Dis. 2021;73(8):1469-1475. doi:10.1093/cid/ciab478.
2. Lee PT, Uy FM, Foo JS, Tan JL. Increased incidence of infective endocarditis in patients with ventricular septal defect. Congenit Heart Dis. 2018;13(6):1005-1011. doi:10.1111/chd.12667
3. Shmueli H, Thomas F, Flint N, Setia G, Janjic A, Siegel RJ. Right-Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment. J Am Heart Assoc. 2020;9(15):e017293. doi:10.1161/JAHA.120.017293.
4. Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, et al. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J. 2023;44(39):3948-4042. Epub 2023 Aug 25. doi:10.1093/eurheartj/ehad193

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.