**4. Risk factors**

	- This is the most common predisposing factor for right sided endocarditis and it ranges between 2 and 5% per year.
	- Approximately 15 opioid overdose deaths and 5 heroin overdose death per 100,000 population reported in 2016, in comparison to 6 opioid overdose deaths and one heroin overdose death per 100,000 population in 2010, according to the Centers for Disease Control data [9]. This growing epidemic of drug abuse constitutes a major risk factor for TVE. In an analysis of the Society of Thoracic Surgeons national database, isolated TV operations were performed in 1613 patients with intravenous drug-associated TV endocarditis between 2011 to 2016 [10].
	- Structural abnormalities of the TV have been noticed in those with chronic use of injected drugs. These abnormalities have been visualized by echocardiography and include leaflet thickening, and/or prolapse with or without regurgitation [11].
	- One of the most common complications of long-term indwelling central venous catheters that are used for long-term hemodialysis or long-term delivery of medications such as chemotherapy has been infection [12]. The incidence of this type of infection is increasing and is parallel to the increase use of indwelling central venous catheters. In the United Sates, it is estimated that about 35,000 cases of catheter-related *Staphylococcus aureus* infection are reported each year with 6% of them developing into endocarditis [13].
	- This is a severe type of infection that is seen in patients with permanent pacemakers and defibrillators, and its incidence has been on the rise due to the increase use of these devices. In a prospective study of 2760 patients by Athan et al. [14], the incidence of cardiac device-related infection was 6.4%. Coexisting valvular involvement was present in 37.3%, of which 24.3% was TVE.

**161**

*Surgery for Tricuspid Valve Endocarditis in the Current Era*

○ The risk of infection after pacemaker implantation is 0.5–1% in the first year after implantation and with the increase complexity of the implanted device, and the need for device replacement or revision procedures, it increases

○ Patients with ventricular septal defect (VSD) and left-to-right shunts are at risk of endocarditis. TV involvement occurs secondary to the jet lesion against the anterior or the septal leaflets of the TV. Current guidelines do not recommend endocarditis prophylaxis anymore in those with acyanotic heart

○ Endocarditis in the presence of atrial septal defects is extremely rare due to the slow velocity of the shunt flow, and only few reported cases exist in the literature. An explanation of such occurrence could be related to the development of tricuspid regurgitation secondary to right ventricular volume

The most predominant organism is *Staphylococcus aureus* (60–90%). In IVDA, there has been an increase in methicillin-resistance and polymicrobial infection [18]. Coagulase-negative Staphylococcus infection occurs more frequently in the presence of prosthetic valves and indwelling central catheters. Although infection with Streptococci can occur (<10%), it remains higher in left-sided endocarditis [19]. There is also increase in infection with Pseudomonas and other gram-negative bacteria. Fungal infection is not uncommon and has been associated with high mortality especially in immunocompromised patients and those with intracardiac

Clinical presentation may vary depending on degree of involvement/destruction of the tricuspid valve and presence or absence of complications. The most common presentation has been persistent fever, chills, anorexia, fatigue, cough, dyspnea, dizziness, cardiac murmur, and varying degrees of heart failure. Septic shock may

The most common complications are related to valvular destruction with subsequent varying degrees of tricuspid regurgitation. Large vegetations can lead to valvular obstruction or recurrent septic pulmonary embolization (**Figure 1(A)**) and hemoptysis or pulmonary abscesses (**Figure 1(B)**). This repeat pulmonary embolization can result in elevation of the right-sided pressures, which in the presence of atrial level shunting, can lead to systemic embolization as well [21]. In severe cases, abscess formation is not uncommon [22], so as varying degrees of atrioventricular block. Acute diffuse glomerulonephritis secondary to immune complex formation and complement C3 deposition in the renal glomeruli resulting in acute renal failure

defects due to the low risk of its occurrence in this population [16].

overload which increases the risk of TV involvement [17].

*DOI: http://dx.doi.org/10.5772/intechopen.95365*

further [15].

**5. Microbiology**

devices [20].

**6. Clinical presentations**

**7. Complications of tricuspid endocarditis**

occur in severe cases.

• *Congenital Heart Defects*


*Advanced Concepts in Endocarditis - 2021*

silent embolization to the lung overtime.

• *Intravenous Drug Abuse (IVDA)*

tis between 2011 to 2016 [10].

regurgitation [11].

• *Long-term Indwelling Catheters*

• *Implantable Cardiac Devices*

and it ranges between 2 and 5% per year.

Isolated TVE has been reported to have a favorable prognosis and good response to medical therapy with few exceptions. Ginzton and colleagues studied 16 patients (12 had history of IVDA) with TVE to define echocardiographic criteria to help identifying those at risk for complications or need for TV surgery [8]. The authors concluded that TV vegetations tend to resolve with time, however, those with persistent infection, cardiomegaly and right heart failure are at increased risk, and no M mode or two-dimensional echocardiographic feature is a predictor of outcome. This tendency for TV vegetations to resolve overtime is different from left-sided endocarditis which tend to persist. This could be related to bacteriological cure or

○ This is the most common predisposing factor for right sided endocarditis

○ Approximately 15 opioid overdose deaths and 5 heroin overdose death per 100,000 population reported in 2016, in comparison to 6 opioid overdose deaths and one heroin overdose death per 100,000 population in 2010, according to the Centers for Disease Control data [9]. This growing epidemic of drug abuse constitutes a major risk factor for TVE. In an analysis of the Society of Thoracic Surgeons national database, isolated TV operations were performed in 1613 patients with intravenous drug-associated TV endocardi-

○ Structural abnormalities of the TV have been noticed in those with chronic use of injected drugs. These abnormalities have been visualized by echocardiography and include leaflet thickening, and/or prolapse with or without

○ One of the most common complications of long-term indwelling central venous catheters that are used for long-term hemodialysis or long-term delivery of medications such as chemotherapy has been infection [12]. The incidence of this type of infection is increasing and is parallel to the increase use of indwelling central venous catheters. In the United Sates, it is estimated that about 35,000 cases of catheter-related *Staphylococcus aureus* infection are reported each year with 6% of them developing into endocarditis [13].

○ This is a severe type of infection that is seen in patients with permanent pacemakers and defibrillators, and its incidence has been on the rise due to the increase use of these devices. In a prospective study of 2760 patients by Athan et al. [14], the incidence of cardiac device-related infection was 6.4%. Coexisting valvular involvement was present in 37.3%, of which 24.3% was

**3. Natural history**

**4. Risk factors**

**160**

TVE.

