Cardiology 75: 2 87-288 (1988) © 1988 S. Kargcr AG. Basel 0008-6312/88/0754-0287S2.75/0 Surgical Excision of the Vegetation as Treatment of Tricuspid Valve Endocarditis Paulo R.B. Evora, José Carlos F. Brasil, Maria Lucia C. Elias, Jorge R.G. Arévalo, Ricardo N. Sgarbieri, Antonio Carlos Menardi, Paulo J.F. Ribeiro Department of Cardiothoracic Surgery and Intensive Care, Sao Francisco Hospital, Ribcirao Prcto, Sao Paulo, Brazil Key Words. Bacterial endocarditis • Tricuspid valve • Surgical treatment • Cardiac surgery • Vegetectomy Abstract. The usual surgical treatment of tricuspid endocarditis is valve replacement or valve excision alone without valve replacement. ‘Vegetectomy’, i.e. local excision of the vegetation and leaflet repair, has been previously described and can be applied to cases with well-circumscribed vegetations and little or no valve damage. A case of tricuspid valve endocarditis successfully managed by surgical excision of the vegetation is reported. Introduction The two techniques usually employed for the surgical treatment of tricuspid valve endo carditis are valve replacement or simple valve excision without valve replacement [1-3]. A third approach is a more conservative proce dure consisting of resection of the vegetation (‘vegetectomy’) and leaflet repair. Case Report A 4'/2-year-old female child, weighing 15.2 kg, pre sented with a Stevens-Johnson syndrome related to the use of a carbamazepine anticonvulsant (Tegretol) and was treated with corticosteroid and the use of an indwelling venous catheter. The patient developed tricuspid valve endocarditis associated with fever, petechiae, hepatosplenomegaly, pulmonary abscesses, tricuspid valve insufficiency, and a disseminated in travascular coagulopathy. Blood cultures and culture of the venous catheter tip grew out Staphylococcus aureus resistant to amoxicillin, amphicillin, carbeni- cillin, and oxacillin. Two-dimensional echocardiogra phy showed a vegetation of 1.5 X 0.8 X 1.2 cm adherent to the atrial surface of the anterior leaflet of the tricuspid valve which prolapsed into the right ventricle during atrial systole (fig. 1). She received oxacillin and cefotaxime. She failed to improve on medical therapy, and surgical treatment was under taken. The vegetation and part of the tricuspid valve were resected through a right atriotomy using cardio pulmonary bypass. The vegetation proved to be larger than revealed by preoperative echocardiography. Vancomycin was used in the perioperative period. The child made a good recovery and subsequent echo- cardiograhic examinations disclosed no evidence of recurrence. Clinically insignificant tricuspid valvular insufficiency remained. Downloaded by: Karolinska Institutet, University Library 130.237.122.245 - 1/16/2019 5:48:19 AM