An Unusual Case of a Double Tricuspid and Mitral Valves Infective Endocarditis Complicated by Multiple Septic Embolisms Secondary to an Atrial Septal Defect: A Case Report and Review of Literature

Abstract

Multivalvular endocarditis (MVE) is an uncommon infection that mostly involves mitral and aortic valves, and it is related to a higher risk of congestive heart failure and a higher mortality. We described a case of a bilateral MVE and performed a review of the literature on similar clinical cases. We reported an unusual case of a 68-year-old male patient with a tricuspid and mitral infective endocarditis due to a methicillin-resistant Staphylococcus aureus complicated by multiple right- and left-sided septic embolization (lungs, brain, spleen, L2-L3 vertebral bones) due to an unknown atrial septal defect identified and repaired during cardiac surgery. Despite the severity of the clinical case, the patient experienced a good clinical outcome also thanks to a multidisciplinary approach. We identified 21 case reports describing bilateral MVE. A multidisciplinary approach is essential in the management of valve diseases to improve the prognosis of patients, especially in bilateral MVE.

Keywords: cardiac surgery; endocarditis team; multiple valve endocarditis; right- and left-sided endocarditis.

Figure 1

(A–D). Transoesophageal echocardiography performed in our hospital. (A): Mid-esophageal four-chamber view at 0° in TOE showing a 16 × 10 mm isoechoic vegetation on tricuspid posterior leaflet (white arrow) and another 13 × 13 mm isoechoic vegetation on mitral posterior leaflet (black arrow). (B): Mid-esophageal off axis view at 30° in TOE showing an isoechoic 14 mm vegetation on posterior mitral leaflet. (C,D): Mid-esophageal mitral commissural view at 60° in TOE showing an isoechoic vegetation on atrial side of mitral P3 scallop in different cardiac cycles (systole (C) and diastole (D)).

Figure 2

Flow-diagram of studies included in the review.