To our knowledge, there have been no reports of right-sided infective endocarditis (RSIE) with ventricular free wall vegetation caused by Abiotrophia defectiva. We herein report a case of RSIE caused by A. defectiva with ventricular free wall vegetation in a 27-year-old man with ventricular septal defect (VSD). Computed tomography showed multiple bilateral pulmonary nodular shadows. Transesophageal echocardiography (TEE) demonstrated right ventricular free wall vegetation at the jet stream. Blood culture revealed A. defectiva. These findings are consistent with a diagnosis of infective endocarditis and septic pulmonary embolism. Treatment with ceftriaxone and gentamicin and subsequent surgical VSD closure improved the patient's condition without recurrence.

Background The natural history and optimal interventional timing in patients with isolated severe tricuspid regurgitation (TR) have not been well studied. This study aimed to investigate long‐term clinical outcomes and risk factors associated with poor prognosis in patients with isolated severe TR. Methods and Results Consecutive transthoracic echocardiographic examinations in 2877 patients with isolated severe TR were retrospectively reviewed. Patients with significant left‐sided valve disease or repeated examinations were excluded. Primary outcome was defined as a composite of all‐cause death and hospitalization for heart failure. Among the 613 enrolled patients (mean age, 74±13 years; men, 38%), 141 died, and 62 were hospitalized for heart failure during the median follow‐up period of 26.5 (interquartile range, 6.0–57.9) months. The 5‐year event‐free rate was 60.1%. TR pressure gradient (adjusted hazard ratio [HR], 1.03 [95% CI, 1.01–1.04]), blood urea nitrogen (adjusted HR, 1.02 [95% CI, 1.01–1.04]), left atrial volume index (adjusted HR, 1.01 [95% CI, 1.002–1.02]), and serum albumin (adjusted HR, 0.56 [95% CI, 0.36–0.95]) were identified as independent predictors of adverse events. A risk model based on the 4 clinical factors that included pulmonary hypertension (TR pressure gradient >40 mm Hg), elevated blood urea nitrogen levels (>25 mg/dL), decreased albumin levels (<3.7 g/dL), and left atrial enlargement (left atrial volume index <34 mL/m 2 ) revealed a graded increase in the risk of adverse events ( P <0.001). Conclusions The prognosis of isolated severe TR is not always favorable. Careful attention should be paid to patients with concomitant risk factors, such as pulmonary hypertension, elevated blood urea nitrogen levels, decreased albumin levels, and left atrial enlargement.

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Background: A high permanent pacemaker implantation (PPI) risk remain a concern of self-expandable transcatheter aortic valve implantation (TAVI), despite continued improvements in implantation methodology. We aimed to assess the impact of real-time direct visualization of the membranous septum using transjugular intracardiac echocardiography (ICE) during TAVI on reducing the rates of conduction disturbances including the need for PPI. Methods: Consecutive patients treated with Evolut R and Evolut PRO/PRO+ from February 2017 to September 2022 were included in this study. We compared outcomes between the conventional implantation method using the 3-cusps view ("3-cusps without ICE" group), the recent method using cusp-overlap view ("cusp-overlap without ICE" group), and our novel method using ICE ("cusp-overlap with ICE" group). Results: Of the 446 patients eligible for analysis, 211 (47.3%) were categorized as the "3-cusps without ICE" group, 129 (28.9%) were in the "cusp-overlap without ICE" group, and 106 (23.8%) comprised the "cusp-overlap with ICE" group. Compared with the "3-cusps without ICE" group, the "cusp-overlap without ICE" group had a smaller implantation depth (2.2 [IQR 1.0-3.5] mm vs 4.3 [IQR: 3.3-5.4], P <0.001) and lower 30-day PPI rates (7.0% vs 14.2%, P = 0.035). Compared with the "cusp-overlap without ICE" group, the "cusp-overlap with ICE" group had lower 30-day PPI rates (1.0%, P = 0.014), albeit with comparable implantation depths (1.9 [IQR 0.9-2.9] mm, P = 0.150). Multivariable analysis showed that our novel method using ICE with the cusp-overlap view was independently associated with a 30-day PPI rate reduction. There were no group differences in 30-day all-cause mortality (1.4% vs 1.6% vs 0%; P = 0.254). Conclusions: Our novel implantation method using transjugular ICE, which enabled a real-time direct visualization of the membranous septum, achieved a predictably high position of prostheses, resulting in a substantial reduction of conduction disturbances requiring PPI after TAVI.

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