Authors

• Iva Ladić — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0003-0124-5256
• Renata Ivanac Janković — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0003-4949-3953
• Ivana Petrović Juren — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0002-2793-3455
• Gabriela Bašković — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0000-0002-5413-873X
• Matea Lukaš — Bjelovar General Hospital, Bjelovar, Croatia — ORCID: 0009-0001-8796-2936

Keywords

parachute tricuspid valve, papillary muscle, endocarditis

DOI

Full Text

Young female patient aged 42 who has been in intermittent hemodialysis program via Tesio catheter for 11 years following bilateral nephrectomy performed because of renal carcinoma, has been recently diagnosed with catheter sepsis (Enterococcus faecalis sepsis). Transthoracic echocardiography was performed and small left coronary aortic cusp vegetation on aortic side of the valve has been visualized (3x3 mm in size), with no signs of valve disfunction. Patient has been treated with vancomycin, without permanent catheter extraction since no other vascular access for hemodialysis was available and sepsis was very well medically controlled. Nevertheless, coincidentally, rare anomaly of tricuspid valve has been also demonstrated. One single, dominant hypertrophied, abnormal placed papillary muscle has been visualized having root attachment in the apex of the right ventricle with relatively short chordae tendineae ( Figure 1 , Figure 2 ). Only mild tricuspid regurgitation has been verified, with no sings od tricuspid stenosis. Right ventricle function and size seemed to be normal. These characteristic morphological features will likely present the case of a parachute tricuspid valve anomaly. Also, interestingly, significantly hypertrophied papillary muscles in small, hypertrophied left ventricle have been shown. Magnetic resonance of the heart was also performed, showing normal sized and shaped right ventricle (EDV 110 ml), having normal systolic function (EF 66%), with no signs of other congenital heart defects or abnormal masses in the cavity of the right ventricle. Parachute tricuspid valve anomaly is very rare congenital heart disease that has not yet been thoroughly investigated. ( 1 - 3 ) It is presented with one single dominant papillary muscle in the right ventricle, resulting in tricuspid valve regurgitation, stenosis or uncommonly, like in our case, normally functioning valve. Transthoracic two-dimensional right ventricular inflow view showing one single hypertrophied papillary muscle. Transthoracic two-dimensional apical 4-chamber view showing one papillary muscle.