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A-30-Year-Old-Woman-With-Tricuspid-Valvectomy-Pres
A-30-Year-Old-Woman-With-Tricuspid-Valvectomy-Pres
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A 30-year-old woman presented to a university hospital with symptoms of worsening fever, chills, body aches, nausea, and vomiting. She has a history of intravenous (IV) heroin use, resulting in tricuspid valve methicillin-resistant Staphylococcus aureus (MRSA) infective endocarditis, leading to a tricuspid valvectomy three years prior. Frequent hospital readmissions in the past year for MRSA bacteremia were noted, although treatments were often left incomplete as she frequently left against medical advice.<br /><br />On examination, the patient exhibited signs of shock, including high heart and respiratory rates, and low blood pressure even after fluid resuscitation. An ultrasound revealed a severely dilated and dysfunctional right ventricle, alongside paradoxical septal motion indicative of right heart failure. Blood cultures confirmed MRSA bacteremia.<br /><br />Infective endocarditis affecting the right side of the heart is uncommon, particularly among IV drug users like this patient, with Staphylococcus aureus being the usual culprit. Surgical intervention is sometimes required when medical management fails, in cases of severe valve damage, or when complications like pulmonary embolism occur. Tricuspid valvectomy is sometimes preferred over replacement, particularly in IV drug users due to high reinfection rates. Although feasible without a tricuspid valve, the procedure can lead to chronic volume overload and subsequent right heart failure due to unimpeded blood flow.<br /><br />With the ongoing opioid crisis, tricuspid valvectomy might become a more common surgery. The case underscores the importance of ultrasonography in evaluating heart function post-valvectomy and suggests a need for more research into the long-term effects and management strategies for patients undergoing this procedure.
Keywords
MRSA infective endocarditis
tricuspid valvectomy
intravenous heroin use
right heart failure
Staphylococcus aureus
ultrasound evaluation
opioid crisis
chronic volume overload
surgical intervention
blood cultures
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