Eustachian Valve Endocarditis: Echocardiographic Diagnosis in a Critical Care Patient

Eustachian and Tricuspid Valve Endocarditis: A Rare Consequence of the Automatic Implantable Cardioverter-Defibrillator Placement

Eustachian valve (EV) is usually a rudimentary structure in adults. It is an embryological remnant of sinus venosus that directs oxygenated blood from the inferior vena cava across the foramen ovale and into the left atrium. Intravenous drug use is most commonly associated with infective endocarditis of the right-sided heart structures. Other documented causes of such an occurrence are intracardiac devices like pacemakers and central venous catheters. Patients presenting with concerns of infection and embolic phenomenon should promptly undergo evaluation for infective endocarditis. Although an embryological remnant, the eustachian valve normally regresses after birth, except in a minority of the patients, it persists as a vestigial structure. Here we present an unusual case involving infective endocarditis of the eustachian valve and tricuspid valve both in a patient with recent automatic implantable cardioverter-defibrillator (AICD) placement and history of IV drug abuse and its systemic consequences in a patient with patent foramen ovale.

Eustachian valve endocarditis: Its presentation and clinical characteristics

A 25-year-old female with history of intravenous drug abuse and tricuspid valve endocarditis presented for evaluation of recurrent endocarditis. Transthoracic echocardiography followed by transesophageal echocardiography revealed vegetation on the eustachian valve and was without evidence of vegetation on the tricuspid valve. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. She was treated with six weeks of intravenous antibiotic therapy but ultimately required tricuspid valve replacement due to severe tricuspid regurgitation. One month later, the patient was found to have bilateral septic pulmonary emboli. We report this rare finding of Eustachian valve endocarditis and review similar previously reported cases in the literature. <Learning objective: To be aware of the rare presentation of Eustachian valve endocarditis, its risk factors, workup, and management.>.

Eustachian valve endocarditis: a case report on an under diagnosed entity

Patients presenting with bacteremia and the presence of multiple infected emboli sites should be promptly investigated for heart valve endocarditis as the possible culprit. We present a case of Eustachian valve endocarditis secondary to multiple abdominal surgeries to highlight not only the importance of recognizing risks factors, other than intravenous drug use, in the pathogenesis of right sided endocarditis, but also to illustrate the significance of systematically interrogating all the heart valves, including the Eustachian valve during echocardiography.

A case report of eustachian valve endocarditis due to Salmonella typhimurium in an AIDS patient

Introduction

The eustachian valve is a normal remnant of the right valve of the sinus venosus, which directs blood in the embryo life from the inferior vena cava into the left atrium through the foramen ovale.

Case report

We report a case of eustachian valve endocarditis (EVE) secondary to Salmonella typhimurium in a patient with acquired immunodeficiency syndrome (AIDS). The patient also had concomitant Pneumocystis pneumonia.

Discussion

Salmonella bacteremia is one of the AIDS-defining illnesses, and many patients will have recurrent episodes. Salmonella endocarditis on the other hand is rare, but when present, it has a significant morbidity and mortality. EVE rarely requires surgical intervention, and the appropriate antibiotics are the treatment of choice.

Conclusions

We recommend clinicians to consider obtaining an echocardiography in AIDS patients with Salmonella bacteremia to search for possible endocarditis, as it does change the treatment plan.