Mesa J M, Oliver J, Domínguez F, Larrea J L, Cortina J M, Moreno I, Sobrino J A
Unidad Médico-Quirúrgica de Cardiología (Cirugía Cardíaca), Hospital La Paz, Universidad Autónoma de Madrid.
Rev Esp Cardiol. 1990 Jan;43(1):13-7.
From 1978, 35 patients with right-sided endocarditis were treated at our hospital. There were 25 male and 10 female patients, with ages ranging from 14 to 77 years. The cause was intravenous drug abuse in 27 cases. Positive blood cultures were obtained in 29 cases, isolating staphylococcal organisms in 26 of them. Two-dimensional echocardiography was performed in 30 patients, confirming the diagnosis in 27 of them (90%). Vegetations were found in 25 patients and perivalvular abscess was seen in 4 patients. The management was medical only in 32 patients. Three patients were operated on because of failure to control pyrexia and heart failure, performing total tricuspid valvectomy in two, and only partial in the third one. All the 3 patients had perivalvular tricuspid abscess. There were 2 hospital deaths (5.7%), because of septic shock in drug abusers, one of them after a tricuspid valvectomy. In our experience, right-sided endocarditis is mainly associated with drug abusers and staphylococcal organisms. Two-dimensional echocardiography plays an important role in the diagnosis of this entity. In our series the size of vegetations does not play a role in selection of surgical candidates. The presence of perivalvular abscess was the only predictive factor for surgery. Only a few patients do not respond to medical therapy. In those cases the elective surgical procedure in our criterion and in our patients is tricuspid valvectomy without valve replacement, or if possible, the use of reconstructive or reparative approaches.
