Tricuspid Valve Reconstruction for Endocarditis in a Premature Newborn
Endocarditis in premature infants without congenital heart
disease is exceedingly rare.
We describe a case of a premature infant who required surgical intervention for
tricuspid endocarditis. The patient was a former 30-week gestation who was
transferred to our facility at 18 days of age.
Echocardiogram at this time revealed a new mass on the tricuspid valve
measuring 6 mm in diameter, without evidence of stenosis or regurgitation.
Blood culture was positive for methicillin sensitive staphylococcus aureus, and
he was started on antibiotic therapy with vancomycin and gentamicin. Repeat
echo on day of life 16 showed the vegetation had grown to 6 x 8 mm in size with
mild tricuspid regurgitation prompting transfer to our facility.
Over the next few days, he required supplemental oxygen and developed
hepatomegaly, ascites and peripheral edema. Echocardiogram on day of life 19
showed a larger vegetation, 10 x 8 mm with limited excursion of the leaflets.
There was a mean gradient of 4-6 mmHg across the tricuspid valve and moderate
regurgitation.
Due to clinical signs of systemic venous congestion and persistently positive
blood cultures, the decision was made to proceed with surgery. On his 25th day
of life, at a corrected gestational age of approximately 33 weeks and a weight
of 2 kg, he was taken to the operating room for tricuspid valve repair.
An echocardiogram from post-operative day number 22 demonstrated normal
systolic ventricular function, moderate TR, predominantly right to left
shunting at the PFO, and a mean gradient of 1 mm Hg across the tricuspid valve.
The patient is currently 3 months old, corrected gestational age of 45 weeks.
He is on minimal oxygen support and is tolerating oral feeds.
References
Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Ciculaiton. 2009;119:865-870.
