CASE REPORTS   

Chirurgia 2008 December;21(6):339-42

Copyright © 2008 EDIZIONI MINERVA MEDICA

language: English

Surgical treatment for right sided infrective endocarditis with recurrent pulmonary infarction concurrent with a ventricular septal defect

Hattori R. ¹, Sumida T. ¹, Okada T. ¹, Johno H. ¹, Enoki C. ¹, Nakao Y. ¹, Miyasaka Y. ², Haiden M. ², Dote K. ², Seno K. ², Iwasaka T. ², Imamura H. ¹

¹ Department of Thoracic and Cardiovascular Surgery Kansai Medical University, Hirakata, Osaka, Japan 2 Division of Cardiology, Second Department of Medicine Kansai Medical University, Hirakata, Osaka, Japan

Right sided infective endocarditis (IE) is a relatively rare disease, but it is known that the presence of an unoperated ventricular septal defect (VSD) is a risk factor for IE. However, unlike left sided IE, there are still no clear criteria for the surgical indications in cases of right sided IE, and there has so far been a particularly small number of studies regarding surgery for cases with complications of lung infarction. A 54-year-old male with an unoperated VSD presented with repeated septic pulmonary infarcts from tricuspid IE despite undergoing antibiotic therapy. A transthoracic echocardiogram revealed severe pulmonary regurgitation with vegetation in the pulmonary valve along with severe tricuspid valve regurgitation and so surgery was performed. We performed a tricuspid valve repair and pulmonary valve replacement with tissue prosthetic valve, thus removing the need for active postoperative anticoagulant therapy and preventing complications such as pulmonary hemorrhage. The use of a tissue prosthetic valve, which is believed to enable excellent durability due to its low-pressure system, and the active implementation of valve repair for treating cases of right sided IE are believed to be very useful, particularly for cases with complications of lung infarction.