Right-sided infective endocarditis-review, clinical study

Abstract

The aim of this paper is to review the clinical and laboratory features, treatment and prophylaxis of right- sided infective endocarditis, and in particular to compare the clinical manifestations and the outcome of right-sided endocarditis to left-sided endocarditis. Between November, 2008, and March, 2010, 50 patients were examined and investigated with the diagnosis of definite infective endocarditis. All the patients included in the study follow the diagnostic criteria for infective endocarditis developed by Duke Endocarditis Service (Durham, North Carolina). The patients were divided in two study groups, the first group- 8 (16%) patients with right-sided infective endocarditis and the second group- 42 (84%) patients with left-sided infective endocarditis. In the study, predominately male (68%), the ratio male / female was 2:1; median age was 43.1 years. While the tricuspid valve is the usual site of infection (5 patients, 62.5%), pulmonary (2 patients, 25, %) and Eustachian valve (1 patient, 12,5%) infection was also observed. Right-sided infective endocarditis occurs in intravenous drug users (3 patients), the patients with a permanent pacemaker (1 patient), implantable cardioverter defibrillator (1 patient), prosthetic valve (1 patient), central venous catheter (1 patient), hemodialysis (1 patient), congenital heart disease, Fallot’s tetrad (1 patient), furunculosis (2 patients). Staphylococcus aureus was the most common aetiological organism of right-sided infective endocatis (60%), Staphylococcus epidermidis and Steptococcus viridans were the causes in 20%. For the left- sided infective endocarditis the most common was Steptococcus viridians (40%), while the Staphylococcus aureus was detected in only 10% cases, other organisms, Staphylococcus epidermidis (10%), Steptococcus haemolyticus (10%), Candida albicans (10%), Enterococcus faecalis (10%) also occur less frequently. The usual manifestations of right-sided IE are persistent fever (100%), bacteraemia (62,5%), and multiple septic pulmonary emboli (87,5%), which manifest with chest pain (37,5%), cough (87,5%), haemoptysis (25%). Pulmonary septic emboli was complicated by pulmonary infarction (12,5%), abscess (12,5%) and purulent pulmonary effusion (25%). However, emboli to the lung with subsequent abscess formation occur frequently in patients with tricuspid endocarditis. Systemic emboli most commonly complicate left- sided IE (8 cases, 19%), including three cerebral embolism, two renal arterial embolism, two emboli of the extremities, one embolism of retinal artery. There was a highly significant difference of the risk factors, etiology, clinic, diagnosis and treatment, survival rates between the patients on due to right-sided infective endocarditis compared to left-sided infective endocarditis.