Simultaneous Bilateral Infective Endocarditis with Right Ventricular Mural Involvement

Abstract

A 47-year-old woman without a significant medical history, including no history of intravenous drug abuse, no body piercings, and no tattoos, was referred with a 6-day history of high fever and arthralgia. Blood cultures were all positive for Staphylococcus aureus Meti-S. Transthoracic echocardiography revealed: 1) an irregular thickening of the posterior mitral valve root with mobile extensions projecting toward both the left ventricle and the left atrium (Fig. 1A, Supplementary movie 1); 2) a huge mobile vegetation rising from the upper portion of the right side of the interventricular septum (Fig. 1B, Supplementary movie 2). These findings were confirmed by transesophageal echocardiography (Fig. 1C-G, Supplementary movie 3 and 4), which also disclosed a mild-to-moderate mitral regurgitation (Fig. 1H). A diagnosis of multisite infective endocarditis with right sided mural involvement was made. No point of entry was detected. The patient got quickly worse and was referred for emergency cardiac surgery.1) Intraoperative findings confirmed the presence of a bulky 3 cm-long vegetation attached to the right-sided interventricular septal endocardial surface that reached the pulmonary valve orifice (Fig. 1I, Supplementary movie 5). On the left side of the heart, the surgeon noted the presence of a large vegetation extending to the posterior free wall endocardium that was damaging the root of the mitral posterior leaflet, and destroying several chordae tendineae and the top of the posterior papillary muscle. The surgical procedure consisted of a conservative posterior mitral valve repair and, on the right side, of a single septal vegectomy. The patient was discharged home 38 days after surgery, in stable clinical condition.