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Tricuspid endocarditis in a pre-term parturient
Abstract Number: T3C-3
Abstract Type: Case Report/Case Series
Infective endocarditis in pregnancy is rare, however it is increasing in prevalence due to its association with IV drug use and carries a high mortality (10-15%) for both mother and fetus (1). While the mitral and aortic valves are most commonly infected (2), we present a rare case of tricuspid endocarditis utilizing a multidisciplinary approach.
A 30-year-old G4P2 female with a history of untreated hepatitis C, IV drug use (on buprenorphine), prior history of DVT, and Methicillin Sensitive Staphylococcus aureus (MSSA) bacteremia. She presented at 29 weeks with progressive malaise, fevers, pelvic pain and an abnormal urinalysis concerning for sepsis of urinary origin. She developed septic shock shortly after presentation. Magnetic resonance imaging studies were significant for pulmonary septic emboli. An echocardiogram demonstrated a mobile mass (1.2 x 5.0 cm) on the tricuspid valve (attached image), diagnostic for acute infective endocarditis. Maternal fetal medicine, infectious disease, cardiology, anesthesiology and cardiothoracic surgery followed this patient closely, and her status improved on tailored IV antibiotic therapy.
Due to the significant maternal morbidity associated with cardiac surgery during pregnancy, combined with the patient’s improvement in clinical status (decreased size of mass) on antibiotic therapy, she did not undergo cardiothoracic surgery at time of diagnosis. She continued on a long-term course of IV antibiotics, her fetus remained stable, and the pregnancy progressed. Although risk of epidural abscess is low, there was concern for neuraxial analgesia given her bacteremia. Subsequent blood cultures while on IV antibiotics were negative and we elected to proceed with epidural placement following induction of labor at 37 weeks gestation. Due to decline in fetal status, she was delivered via cesarean by extending her epidural anesthetic. Her baby is doing well and the patient is pursuing further treatment for HCV prior to undergoing tricuspid valve replacement.
1. Kebed KY, Bishu K, et al. Pregnancy and postpartum infective endocarditis: A systematic review. Mayo Clinic Proceedings. August 2014;89(8):1143-1152.
2. Murdoch DR, Corey GR, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med. 2009;169(5):463-473.