Dumani Selman, Beca Vera, Pellumbi Devis, Llazo Stavri, Rruci Edlira, Teferici Daniela, Veshti Altin
Cardiac Surgery, University Hospital Center "Mother Theresa", Tirana, ALB.
Nosocomial Infections, University Hospital Obstetrics and Gynecology "Queen Geraldina", Tirana, ALB.
Cureus. 2025 Aug 11;17(8):e89781. doi: 10.7759/cureus.89781. eCollection 2025 Aug.
Infective endocarditis involving the right ventricular outflow tract (RVOT) is rare, even among intravenous drug users, and is infrequently encountered by cardiac surgery teams. We report the case of a 30-year-old man with a history of intravenous drug use who presented with a two-month history of fever reaching 39℃. He was initially treated with antibiotics. Transthoracic and transesophageal echocardiography revealed a 2 cm² vegetation on the anterior leaflet of the tricuspid valve, causing severe tricuspid regurgitation, along with a thin, highly mobile, pedunculated mass (1.8-2 cm²) in the RVOT. Surgical intervention was indicated due to the size and mobility of both lesions and the patient's clinical history. The patient underwent tricuspid valve replacement with a No. 33 Epic Supra bioprosthesis and excision of the RVOT mass. Histopathological examination confirmed fibrinous-thrombotic vegetation in both locations. The postoperative course was uneventful. Right-sided infective endocarditis is closely associated with intravenous drug use, with the tricuspid valve being the most commonly affected site. Involvement of the RVOT is rare but should be considered. Surgery remains the gold standard for definitive diagnosis and treatment in such atypical cases and can result in a favorable outcome.
感染性心内膜炎累及右心室流出道（RVOT）较为罕见，即便在静脉吸毒者中亦是如此，心脏外科团队也很少遇到这种情况。我们报告一例30岁有静脉吸毒史的男性患者，发热达39℃已持续两个月。他最初接受了抗生素治疗。经胸和经食管超声心动图显示，三尖瓣前叶有一个2cm²的赘生物，导致严重的三尖瓣反流，同时在右心室流出道有一个薄的、活动度高的带蒂肿物（1.8 - 2cm²）。鉴于两个病变的大小、活动度以及患者的临床病史，需进行手术干预。患者接受了33号Epic Supra生物瓣三尖瓣置换术及右心室流出道肿物切除术。组织病理学检查证实两个部位均为纤维蛋白血栓性赘生物。术后过程顺利。右侧感染性心内膜炎与静脉吸毒密切相关，三尖瓣是最常受累的部位。右心室流出道受累罕见，但应予以考虑。手术仍然是此类非典型病例明确诊断和治疗的金标准，且可带来良好预后。
