CASE REPORT - A COMPLEX CASE OF INFECTIVE ENDOCARDITIS, PULMONARY EMBOLISM.

Objective

A 32 year old male patient with history of IV drug abuse with heavy alcohol intake presented to the hospital with high fever, rigors, shortness of breath and productive cough. Physical examination revealed malnutrition, diffuse petechial lesions and significant peripheral edema. Echocardiographic evaluation revealed 3.4 × 2.9 cm vegetation attached to all 3 leaflets of Tricuspid Valve with CTPA scan suggestive of pulmonary embolism to left lower lobe.

Design and method

Our team optimised patient from haematological, microbiological, nutritional and psychological aspect for 21 days. Multidisciplinary team decided for a surgical intervention as a lifesaving procedure in this complex situation with high risk. Despite sequential echo assessment prior to the day of surgery incidental finding on Intraoperative TOE assessment was a new vegetation on Non coronary and left coronary cusp with mild to mod Aortic regurgitation. Tricuspid valve was replaced with bio prosthetic valve and aortic valve vegetation and perforation was repaired with a small pericardial strip.

In the post-operative period patient was haemodynamically stable on minimum inotropic support. He required CVVH Support for 2 days. Full recovery was achieved in next 7 days and patient was discharged home.

Results and conclusions

Discussion-Infective endocarditis with pulmonary embolism, anaemia, thrombocytopenia, coagulopathy and immunological dysregulation made our patient challenging one to manage . We emphasise on multidisciplinary approach in managing and optimising such complex case prior to surgery along with the importance of peri-operative transoesophageal echocardiography in the decision making process which has lead us to a successful outcome.