Idris Ahmed Sifeeldein Ahmed, Nashrah Umme, Amara Umm E, Shaikh Nissar
Hamad General Hospital, Doha, Qatar.
Deccan College of Medical Sciences/Hyderabad, India.
Qatar Med J. 2025 Sep 15;2025(3):93. doi: 10.5339/qmj.2025.93. eCollection 2025.
The eustachian valve (EV) is a remnant of the right sinus venosus valve. It remains different in size and shape without much impact on adult life. In 5% to 10% of all endocarditis, are seen in the right side of the heart is involved, which is rare compared to the left side of the heart. Bacteremia, central venous catheter, heart implants, and drug abuse increase the risk of EV vegetation and right heart endocarditis. We are reporting a case of EV endocarditis in patients with Fournier's gangrene and septic shock.
A 45-year-old male patient was admitted into the surgical intensive care unit with Fournier's gangrene, septic shock, and acute kidney injury (AKI). The patient was managed by invasive ventilation, noradrenaline, vasopressin, and renal replacement therapy. He developed bacteremia and candidemia. We added meropenem and antifungal to the therapy. The transthoracic echocardiography showed EV vegetation and thread-like vegetation in the right coronary sinus, which was confirmed with transesophageal echocardiography. With aggressive therapies, the patient recovered from septic shock, organ dysfunction and was successfully liberated from invasive ventilation. The patient was discharged home on day 27. The antibiotics and antifungal were continued for 6 weeks. Two weeks after discharge, the follow-up echocardiogram was normal, and he was doing well.
Eustachian valve endocarditis is rare, and should be treated with appropriate, culture- and sensitivity-guided antibiotics and or antifungal therapy for 6 weeks. The outcome of EV vegetations of endocarditis is good. The reported mortality is up to 17%. The independent risk factors associated with mortality are AKI, the Charlson comorbidity index, congestive heart failure, larger vegetation, and central nervous system involvement.
The presence of larger EV, along with (ESBL) bacteremia and fungemia, increases the risk of right-sided endocarditis, which is rarely reported. Our patient was diagnosed early, received appropriate antimicrobial treatment for a sufficient duration, resulting in a better outcome. A high index of suspicion, along with early diagnosis and culture-guided 6-week antimicrobial therapy, will improve the patient's outcomes.
咽鼓管瓣（EV）是右静脉窦瓣的遗迹。其大小和形状各异，对成年生活影响不大。在所有心内膜炎病例中，5%至10%累及心脏右侧，与心脏左侧相比较为罕见。菌血症、中心静脉导管、心脏植入物及药物滥用会增加EV赘生物和右心内膜炎的风险。我们报告一例患有福尼埃坏疽和感染性休克患者的EV心内膜炎病例。
一名45岁男性患者因福尼埃坏疽、感染性休克和急性肾损伤（AKI）入住外科重症监护病房。患者接受有创通气、去甲肾上腺素、血管加压素及肾脏替代治疗。他出现了菌血症和念珠菌血症。我们在治疗中加用了美罗培南和抗真菌药物。经胸超声心动图显示EV赘生物及右冠状动脉窦内的线状赘生物，经食管超声心动图得以证实。通过积极治疗，患者从感染性休克、器官功能障碍中康复，并成功脱离有创通气。患者于第27天出院。抗生素和抗真菌药物持续使用6周。出院两周后，随访超声心动图正常，患者情况良好。
咽鼓管瓣心内膜炎罕见，应使用适当的、根据培养和药敏结果指导的抗生素及或抗真菌治疗6周。心内膜炎的EV赘生物预后良好。报告的死亡率高达17%。与死亡率相关的独立危险因素包括AKI、查尔森合并症指数、充血性心力衰竭、较大的赘生物及中枢神经系统受累。
较大的EV、超广谱β-内酰胺酶（ESBL）菌血症和真菌血症会增加右侧心内膜炎的风险，此类病例鲜有报道。我们的患者早期诊断，接受了足够疗程的适当抗菌治疗，从而获得了较好的预后。高度的怀疑指数，以及早期诊断和培养指导的6周抗菌治疗，将改善患者的预后。
