Authors

• Vedrana Baraban — Clinical Hospital Center Osijek, Osijek, Croatia — ORCID: 0000-0002-9724-0785
• Lana Maričić — Clinical Hospital Center Osijek, Osijek, Croatia — ORCID: 0000-0002-0311-8384
• Krunoslav Šego — Clinical Hospital Center Osijek, Osijek, Croatia — ORCID: 0000-0002-6593-8652
• Grgur Dulić — Clinical Hospital Center Osijek, Osijek, Croatia — ORCID: 0000-0003-2295-3913
• Livija Sušić — Health Centre Osijek, Osijek, Croatia — ORCID: 0000-0001-7271-4449

Keywords

cardiac mass, tricuspid valve, intravenous drug abuse

DOI

Full Text

The present case report describes a 31-year-old mother of two children, who was treated for fever and sepsis syndrome in two occasions in 2015, at the Department of Infectious Diseases. During the second hospitalization, transthoracic echocardiography confirmed a cardiac mass attached to the septal leaflet tricuspid valve. The patient was transferred to the Department of Cardiovascular Diseases at the Clinical Hospital Osijek for further treatment. The patient occasionally consumed various drugs at the age of 15-19, later sporadically, and she was a heavy smoker for 15 years. In 2006, during her first pregnancy, the patient was tested for HIV and hepatitis (the results were negative), whereas in 2014, during the second pregnancy, the results were positive for HBV (antiHBs and antiHBc). In addition to fever, the patient complained of weight loss, night sweats and general weakness. The results of laboratory tests revealed elevated inflammatory parameters (CRP 132). During the first hospitalization Staphylococcus aureus was isolated in blood cultures and the patient was treated with cloxacillin and gentamicin whereas during the second hospitalization Pseudomonas aeruginosa was isolated and the therapy included cefepim and ciprofloxacin. The transthoracic echocardiography (**Figure 1****,** **Figure 2**) showed normal dimensions of cardiac chambers, normal global and regional contractility of LV and DV and a cardiac mass on the stalk attached to the tricuspid annulus which during the cardiac cycle protruded into the right ventricle and consequently caused a moderately severe TR 2-3+ with RVSP about 40 mmHg. Figure 1. A transthoracic echocardiogram. Apical four chamber view: cardiac mass 12x19 mm which attached to the septal leaflet tricuspidal valve. Figure 2. A transthoracic echocardiogram. Subcostal view: cardiac mass protrudes in right ventricle and pulmonary artery depending on the phase of cardiac cycle. After six weeks of antibiotic therapy, the patient was transferred to the Department of Cardiac Surgery where she underwent surgery with removal of the cardiac mass and a portion of septal leaflet tricuspid valve. Histopathological assessment described the removed cardiac mass as part of the tricuspid valve with vegetation built of fibrin pervaded by granulocytes and colonies of microorganisms were observed – in conclusion acute endocarditis. (1-3) The postoperative recovery was uneventful, but regarding the tricuspid regurgitation, a reconstruction of tricuspid valve is planned within two years.

Literature

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