Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA.
Cardiothoracic Surgery, University of Kentucky Medical Center, Lexington, Kentucky, USA.
BMJ Case Rep. 2022 May 27;15(5):e250272. doi: 10.1136/bcr-2022-250272.
Intravenous drug use (IVDU) is a growing public health crisis worldwide. A known complication of IVDU is right-sided infective endocarditis (RSIE) involving the tricuspid valve. As the tricuspid valve is burdened with infectious vegetations, it becomes a potential source of pulmonary and, very rarely, paradoxical systemic emboli. We report two patients with RSIE involving the tricuspid valve presenting with acute change in mental status. Subsequent imaging demonstrated embolisation to the brain in the setting of elevated right atrial pressures and the presence of a patent foramen ovale (PFO) with right-to-left shunting. We employed a strategy of percutaneous closure of PFO, to prevent further embolisation, as a successful bridge to definitive surgical management of RSIE. We emphasise that clinicians should evaluate for intracardiac shunting and pursue transesophageal echocardiography when encountering systemic emboli of unknown origin, particularly in patients with RSIE.
静脉药物滥用（IVDU）是全球日益严重的公共卫生危机。IVDU 的已知并发症之一是涉及三尖瓣的右侧感染性心内膜炎（RSIE）。由于三尖瓣受到感染性赘生物的影响，它成为肺栓塞的潜在来源，且极罕见情况下为反常性体循环栓塞。我们报告了两名因 RSIE 累及三尖瓣导致精神状态急性改变的患者。随后的影像学检查显示，在右心房压力升高和卵圆孔未闭（PFO）伴右向左分流的情况下，发生了脑部栓塞。我们采用了经皮 PFO 封堵的策略，以防止进一步栓塞，作为 RSIE 确定性手术治疗的成功桥梁。我们强调，临床医生在遇到不明原因的体循环栓塞时，应评估心内分流，并进行经食管超声心动图检查，特别是在 RSIE 患者中。
