DOI: 10.1161/circ.148.suppl_1.17584 ISSN: 0009-7322

Abstract 17584: Tricuspid Valve Infective Endocarditis: A Catastrophic Complication of Preterm Rupture of Membranes

Geethika Earthineni, Somshukla Ghosh, Divya R Verma, Kishore Harjai, Roland Njoh, Hanumanth K Reddy
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Background: Few cases of post-partum complication of Group B Streptococcus (GBS) tricuspid valve (TV) infective endocarditis (IE) after live vaginal birth have been reported. We present the same, further complicated by septic emboli tospleen through patent foramen ovale (PFO).

Case: 33-year-old 4 weeks post-partum female (G7P6) in septic shock was diagnosed with GBS TV IE with 41mm X 21mm vegetation(F1) with septic emboli to lungs and spleen. Echocardiogram showed PFO with right to left shunt. Ceftriaxone and Gentamycin were started. Her pregnancy was complicated with preterm premature rupture of membrane (PPROM); she had received no antenatal care. Vegetation was debulked with AngioVac procedure (AVP) while PFO was occluded with trans-septal compliant balloon(F2). After recovery from acute illness TV was replaced with bioprosthetic valve.

Decision-Making: IE was most likely a post-partum complication in absence of IV drug use, intravascular device, right sided cardiac anomaly. Large size of vegetation with embolization warranted use of AVP to debulk the vegetation as a bridge to valve surgery. PFO occlusion with balloon during AVP prevented potential catastrophic embolization to the brain.

Conclusion: Mothers colonized with GBS routinely get antibiotics to prevent transmission to the newborn; this case highlights the need for GBS screening and treatment to reduce maternal morbidity as well. Minimally invasive AVP can debulk vegetations thus decreasing infectious burden and risk of septic embolization before surgery.

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