Eustachian valve infective endocarditis

A 46-year-old woman with a history of end-stage renal disease on chronic haemodialysis presented with 1 week of fever, chills, altered mental status and hand pain. She was febrile and ill-appearing on presentation with a pulse rate of 102 beats per minute. She had a tunnelled dialysis catheter in her right neck. Hand examination demonstrated a swollen, erythematous and tender wrist. Cardiovascular examination demonstrated no murmurs. CT of the hand showed abscesses involving the left forearm. Blood and abscess cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Transesophageal echocardiography (TEE) showed a 1.0×1.0 cm mobile vegetation involving the eustachian valve (EV), confirming EV endocarditis. She remained bacteraemic for 18 days despite being on vancomycin with appropriate blood levels. Vancomycin was switched to daptomycin and ceftaroline, which cleared her cultures. Repeat TEE showed improved vegetation size. Our case highlights the rarity and management of EV endocarditis and the importance of synergy for treatment of persistent MRSA bacteraemia.

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Right‐Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment

Shmueli

Thomas

Flint

et al. 2020

JAHA

180

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Compared with the extensive data on left‐sided infective endocarditis ( IE ), there is much less published information on the features and management of right‐sided IE . Right‐sided IE accounts for 5% to 10% of all IE cases, and compared with left‐sided IE , it is more often associated with intravenous drug use, intracardiac devices, and central venous catheters, all of which has become more prevalent over the past 20 years. In this manuscript on right‐sided IE we provide an up‐to‐date overview on the epidemiology, etiology, microbiology, potential locations of infection in the right heart, diagnosis, imaging, common complications, management, and prognosis. We present updated information on the treatment of pacemaker and device infections, infected fibrin sheaths that appear to be an easily missed source of infection after central line as well as pacemaker removal. We review current data on the AngioVac percutaneous aspiration device, which can obviate the need for surgery in patients with infected pacemaker leads and fibrin sheaths. We also focused on advanced diagnostic modalities, such as positron emission tomography/computed tomography. All of these are supported by specific case examples with detailed echocardiographic imaging from our experience.

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Eustachian valve infective endocarditis

Cited by 3 publications

References 7 publications

The Anatomy of the Eustachian Valve—Navigating the Implications for Right-Sided Surgical and Transcatheter Cardiac Interventions

The Anatomy of the Eustachian Valve—Navigating the Implications for Right-Sided Surgical and Transcatheter Cardiac Interventions

Case of eustachian valve endocarditis and the importance of synergistic antibiotic therapy

Right‐Sided Infective Endocarditis 2020: Challenges and Updates in Diagnosis and Treatment

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