Clinical outcomes of severe tricuspid valve infective endocarditis related to intravenous drug abuse - a case series.
BACKGROUND
Right-sided infective endocarditis (IE) related to intravenous drug use (IVDU) can follow an acute fulminant course. However, there is limited information on its longer-term clinical outcomes.


AIM AND METHODS
We assessed a cohort of consecutive patients who presented with IVDU complicated by severe tricuspid valve regurgitation to determine their presentation, treatment, and long-term outcomes. In this study, severe tricuspid regurgitation (TR) was defined by the European Association of Cardiovascular Imaging criteria at initial presentation to the hospital.


RESULTS
Thirty-three patients with a mean age of 35 ± 18 years (72% males) presented with IVDU associated with severe TR. At the initial presentation, 15 patients were in septic shock and required inotropes. 26 patients had septic pulmonary emboli; 10 patients had associated metastatic systemic sites of infection of which 5 patients had central nervous system (CNS) involvement. Three patients were in disseminated intravascular coagulation (DIC) and 1 patient had multi-organ failure (MOF), but not requiring dialysis or mechanical ventilation. Most patients had large tricuspid valve vegetations of >20mm. Eleven patients underwent surgery with 18% perioperative mortality. The Median follow-up was 6.4 years (0.5-11.4). Recurrent IE occurred in one-third of patients, the overall incidence of heart failure and Atrial fibrillation (AF) on follow-up was low in all 3 groups. Five-year survival was 94%.


CONCLUSION
Acute severe TR following associated endocarditis IVDU results in a fulminant initial presentation, but a longer-term prognosis is good with surgical and medical treatment.
['Chong|Cheryl Zhiya|CZ|0000-0002-0492-1873', 'Cherian|Robin|R|', 'Ng|Perryn|P|', 'Yeo|Tiong Cheng|TC|', 'Ling|Lieng Hsi|LH|', 'Soo|Wern Miin|WM|', 'Wong|Raymond Ching Chiew|RCC|', 'Tambyah|Paul Anantharajah|PA|', 'Kong|William Kok-Fai|WK|', 'Tay|Edgar Lik Wui|ELW|']
infective endocarditis intravenous drug use Tricuspid regurgitation heart failure atrial fibrillation