Cover Image: Simultaneous endocarditis involvement of native tricuspid and aortic valves
Demetrio Tallarico, Pier Andrea Chiavari, and Pasquale Mollo
II Division of Cardiology, University ‘La Sapienza’, Rome, Italy
A 45-year-old woman heroine addict with a high fever for 1 month was admitted to the intensive care unit (ICU) for respiratory failure that required mechanical ventilation and general anaesthesia, as well as enteral nutrition. Blood cultures were positive for Staphylococcus auricularis and antibiotic therapy was instituted. Transoesophageal echocardiography (TEE) with conventional probe was attempted but, as occasionally reported in the literature, it was hampered by the presence of nasogastric and endotracheal tubes. This inconvenience was overcome by the nasal introduction of a miniaturized 10F (3.2 mm), monoplane probe developed for intracardiac ultrasounds (AcuNav, Acuson/Siemens). An adequate two-dimensional image demonstrated a large mobile vegetation (red arrow on the left side of figure) on the tricuspid valve; this mass occupied the right ventricular inflow during diastole, without causing any significant atrioventricular obstruction. Furthermore, another prominent and mobile vegetation was visualized on the aortic valve (red arrow on the right side of figure). This lesion moved into the left ventricular outflow tract during diastole, and back into the aortic root during systole, without producing a systolic transvalvular gradient. Mitral and pulmonary valves were not infected. The patient died of cardiac arrest 2 days later.
Figure legend:
Two-dimensional image showing the simultaneous endocarditis involvement of the tricuspid (red arrow on left side) and aortic valves (red arrow on the right side) (LA = left atrium; RA = right atrium; AA = ascending aorta).
[Table of Contents]