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Right-Heart Endocarditis

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Abstract

Right-heart endocarditis accounts for 5–12 % of cases of infective endocarditis (IE). We can distinguish four different types of right-heart endocarditis: IE in intravenous drug users (IVDU); IE in patients with pacemakers, implantable cardiac defibrillators or central venous catheters; IE in patients with right-heart congenital abnormalities, and IE in patients who are not IVDU, who have no implanted cardiac devices or other catheters, and who have no left-sided endocarditis, the so called “three noes” IE group. Diagnostic clinical features of right-heart IE include respiratory symptoms, S. aureus bacteremia, and fever of unclear origin. Transthoracic echocardiography is especially valuable in this scenario. Many IVDU with right-heart IE have a relatively benign clinical course and most of them may be conservatively managed. Nonetheless, 5–10 % of cases will still need surgery and in them a conservative approach is recommended. Recurrences are high in IVDU. Patients from the “three noes” group have more comorbidities, health care related infections, and higher mortality.

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References

  1. Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the task force on the prevention, diagnosis, and treatment of infective endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and by the International Society of Chemotherapy (ISC) for infection and cancer. Eur Heart J. 2009;30(19):2369–413.

    Article  PubMed  Google Scholar 

  2. Leone S, Ravasio V, Durante-Mangoni E, Crapis M, Carosi G, Scotton PG, et al. Epidemiology, characteristics, and outcome of infective endocarditis in Italy: the Italian Study on Endocarditis. Infection. 2012;40(5):527–35.

    Article  CAS  PubMed  Google Scholar 

  3. Axelsson A, Søholm H, Dalsgaard M, Helweg-Larsen J, Ihlemann N, Bundgaard H, et al. Echocardiographic findings suggestive of infective endocarditis in asymptomatic Danish injection drug users attending urban injection facilities. Am J Cardiol. 2014;114(1):100–4.

    Article  PubMed  Google Scholar 

  4. Cooper HL, Brady JE, Ciccarone D, Tempalski B, Gostnell K, Friedman SR. Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clin Infect Dis. 2007;45(9):1200–3.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I, et al. Clinical classification and prognosis of isolated right-sided infective endocarditis. Medicine. 2014;93(27):e137.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Yuan S-M. Right-sided infective endocarditis: recent epidemiologic changes. Int J Clin Exp Med. 2014;7(1):199–218.

    PubMed  PubMed Central  Google Scholar 

  7. San Román JA, Vilacosta I, López J, Revilla A, Arnold R, Sevilla T, et al. Role of transthoracic and transesophageal echocardiography in right-sided endocarditis: one echocardiographic modality does not fit all. J Am Soc Echocardiogr. 2012;25(8):807–14.

    Article  PubMed  Google Scholar 

  8. Ribera E, Miró JM, Cortés E, Cruceta A, Merce J, Marco F, et al. Influence of human immunodeficiency virus 1 infection and degree of immunosuppression in the clinical characteristics and outcome of infective endocarditis in intravenous drug users. Arch Intern Med. 1998;158(18):2043–50.

    Article  CAS  PubMed  Google Scholar 

  9. Saydain G, Singh J, Dalal B, Yoo W, Levine DP. Outcome of patients with injection drug use-associated endocarditis admitted to an intensive care unit. J Crit Care. 2010;25(2):248–53.

    Article  PubMed  Google Scholar 

  10. Bassetti S, Battegay M. Staphylococcus aureus infections in injection drug users: risk factors and prevention strategies. Infection. 2004;32(3):163–9.

    Article  CAS  PubMed  Google Scholar 

  11. Miró JM, del Río A, Mestres CA. Infective endocarditis in intravenous drug abusers and HIV-1 infected patients. Infect Dis Clin North Am. 1997;16(2):273–95.

    Article  Google Scholar 

  12. Sousa C, Botelho C, Rodrigues D, Azeredo J, Oliveira R. Infective endocarditis in intravenous drug abusers: an update. Eur J Clin Microbiol Infect Dis. 2012;31(11):2905–10.

    Article  CAS  PubMed  Google Scholar 

  13. Baddour LM. Twelve-year review of recurrent native-valve infective endocarditis: a disease of the modern antibiotic era. Rev Infect Dis. 1988;10(6):1163–70.

    Article  CAS  PubMed  Google Scholar 

  14. Wilson LE, Thomas DL, Astemborski J, Freedman TL, Vlahov D. Prospective study of infective endocarditis among injection drug users. J Infect Dis. 2002;185(12):1761–6.

    Article  PubMed  Google Scholar 

  15. Moss R, Munt B. Injection drug use and right sided endocarditis. Heart. 2003;89(5):577–81.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Frontera JA, Gradon JD. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin Infect Dis. 2000;30(2):374–9.

    Article  CAS  PubMed  Google Scholar 

  17. Hecht SR, Berger M. Right-sided endocarditis in intravenous drug users. Prognostic features in 102 episodes. Ann Intern Med. 1992;117(7):560–6.

    Article  CAS  PubMed  Google Scholar 

  18. San Román JA, Vilacosta I, Zamorano JL, Almería C, Sánchez-Harguindey L. Transesophageal echocardiography in right-sided endocarditis. J Am Coll Cardiol. 1993;21(5):1226–30.

    Article  PubMed  Google Scholar 

  19. Sande MA, Lee BL, Millills J, Chambers HF. Endocarditis in intravenous drug users. In: Kaye D, editor. Infective endocarditis. 2nd ed. New York: Raven; 1992.

    Google Scholar 

  20. Levine DP, Brown PD. Infections in injection drug users. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone/Elsevier; 2010.

    Google Scholar 

  21. Dressler FA, Roberts WC. Infective endocarditis in opiate addicts: analysis of 80 cases studied at necropsy. Am J Cardiol. 1989;63(17):1240–57.

    Article  CAS  PubMed  Google Scholar 

  22. Naidoo DP. Right-sided endocarditis in the non-drug addict. Postgrad Med J. 1993;69(814):615–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Nandakumar R, Raju G. Isolated tricuspid valve endocarditis in non addicted patients: a diagnostic challenge. Am J Med Sci. 1997;314(3):207–12.

    CAS  PubMed  Google Scholar 

  24. Kido T, Nakata Y, Aoki K, Hata N, Hazama S. Infective endocarditis of the tricuspid valve in a non-drug user. Jpn J Med. 1991;30(2):154–6.

    Article  CAS  PubMed  Google Scholar 

  25. Edmond JJ, Eykyn SJ, Smith LD. Community acquired staphylococcal pulmonary valve endocarditis in non-drug users: case report and review of the literature. Heart. 2001;86(6):E17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Hamza N, Ortiz J, Bonomo RA. Isolated pulmonic valve infective endocarditis: a persistent challenge. Infection. 2004;32(3):170–5.

    Article  CAS  PubMed  Google Scholar 

  27. González-Juanatey C, Testa-Fernández A, López-Alvarez M. Isolated pulmonary native valve infectious endocarditis due to Enterococcus faecalis. Int J Cardiol. 2006;113(1):E19–20.

    Article  PubMed  Google Scholar 

  28. De Alarcón A, Villanueva JL. Endocarditis in parenteral drug addicts. Right-sided endocarditis. Influence of HIV infection. Rev Esp Cardiol. 1998;51 Suppl 2:71–8.

    PubMed  Google Scholar 

  29. Akinosoglou K, Apostolakis E, Koutsogiannis N, Leivaditis V, Gogos CA. Right-sided infective endocarditis: surgical management. Eur J Cardiothorac Surg. 2012;42(3):470–9.

    Article  PubMed  Google Scholar 

  30. Wang TKM, Oh T, Voss J, Pemberton J. Characteristics and outcomes for right heart endocarditis: six-year cohort study. Heart Lung Circ. 2014;23(7):625–7.

    Article  PubMed  Google Scholar 

  31. Que Y-A, Moreillon P. Staphylococcus aureus (including staphylococcal toxic shock). In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. 7th ed. Philadelphia: Churchill Livingstone/Elsevier; 2010.

    Google Scholar 

  32. Li JS, Sexton DJ, Mick N, Nettles R, Fowler Jr VG, Ryan T, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–8.

    Article  CAS  PubMed  Google Scholar 

  33. Chung-Esaki H, Rodriguez RM, Alter H, Cisse B. Validation of a prediction rule for endocarditis in febrile injection drug users. Am J Emerg Med. 2014;32(5):412–6.

    Article  PubMed  Google Scholar 

  34. Weisse AB, Heller DR, Schimenti RJ, Montgomery RL, Kapila R. The febrile parenteral drug user: a prospective study in 121 patients. Am J Med. 1993;94(3):274–80.

    Article  CAS  PubMed  Google Scholar 

  35. Sungur A, Hsiung MC, Meggo Quiroz LD, Oz TK, Haj Asaad A, Joshi D, et al. The advantages of live/real time three-dimensional transesophageal echocardiography in the assessment of tricuspid valve infective endocarditis. Echocardiography. 2014;31(10):1293–309.

    Article  PubMed  Google Scholar 

  36. Vilacosta I, San Román JA, Roca V. Eustachian valve endocarditis. Br Heart J. 1990;64(5):340–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. San Román JA, Vilacosta I, Sarriá C, Garcimartín I, Rollán MJ, Fernández-Avilés F. Eustachian valve endocarditis: is it worth searching for? Am Heart J. 2001;142(6):1037–40.

    Article  PubMed  Google Scholar 

  38. Kwan C, Chen O, Radionova S, Sadiq A, Moskovits M. Echocardiography: a case of coronary sinus endocarditis. Echocardiography. 2014;31(9):E287–8.

    Article  PubMed  Google Scholar 

  39. Habib G, Badano L, Tribouilloy C, Vilacosta I, Zamorano JL. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11(2):202–19.

    Article  PubMed  Google Scholar 

  40. Winslow T, Foster E, Adams JR, Schiller NB. Pulmonary valve endocarditis: improved diagnosis with biplane transesophageal echocardiography. J Am Soc Echocardiogr. 1992;5(2):206–10.

    Article  CAS  PubMed  Google Scholar 

  41. Sawhney N, Palakodeti V, Raisinghani A, Rickman LS, DeMaria AN, Blanchard DG. Eustachian valve endocarditis: a case series and analysis of the literature. J Am Soc Echocardiogr. 2001;14(11):1139–42.

    Article  CAS  PubMed  Google Scholar 

  42. Botsford KB, Weistein RA, Nathan CR, Kabins SA. Selective survival in pentazocine and tripelennamine of Pseudomonas aeruginosa serotype O11 from drug addicts. J Infect Dis. 1985;151(2):209–16.

    Article  CAS  PubMed  Google Scholar 

  43. Bisbe J, Miró JM, Latorre X, Moreno A, Mallolas J, Gatell JM, et al. Disseminated candidiasis in addicts who use brown heroin: report of 83 cases and review. Clin Infect Dis. 1992;15(6):910–23.

    Article  CAS  PubMed  Google Scholar 

  44. Oh S, Havlen PR, Hussain N. A case of polymicrobial endocarditis caused by anaerobic organisms in an injection drug user. J Gen Intern Med. 2005;20(10):C1–2.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Raucher B, Dobkin J, Mandel L, Edberg S, Levi M, Miller M. Occult polymicrobial endocarditis with Haemophilus parainfluenzae in intravenous drug abusers. Am J Med. 1989;86(2):169–72.

    Article  CAS  PubMed  Google Scholar 

  46. Fortun J, Navas E, Martínez-Beltran J, Pérez-Molina J, Martin-Davila P, Guerrero A, et al. Short-course therapy for right-sided endocarditis due to Staphylococcus aureus in drug abusers: cloxacillin versus glycopeptides in combination with gentamycin. Clin Infect Dis. 2001;33(1):120–5.

    Article  CAS  PubMed  Google Scholar 

  47. Ribera E, Gómez-Jimenez J, Cortes E, del Valle O, Planes A, González-Alujas T, et al. Effectiveness of cloxacillin with and without gentamicin in short-term therapy for right-sided Staphylococcus aureus endocarditis. A randomized, controlled trial. Ann Intern Med. 1996;125(12):969–74.

    Article  CAS  PubMed  Google Scholar 

  48. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18–55.

    Article  PubMed  Google Scholar 

  49. Soriano A, Marco F, Martínez JA, Pisos E, Almela M, Dimova VP, et al. Influence of vancomycin minimum inhibitory concentration on the treatment of methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis. 2008;46(2):193–200.

    Article  CAS  PubMed  Google Scholar 

  50. Fowler Jr VG, Boucher HW, Corey GR, Abrutyn E, Karchmer AW, Rupp ME, et al. Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med. 2006;355(7):653–65.

    Article  CAS  PubMed  Google Scholar 

  51. Rose WE, Leonard SN, Sakoulas G, Kaatz GW, Zervos MJ, Sheth A, et al. Daptomycin activity against Staphylococcus aureus following vancomycin exposure in an in vitro pharmacodynamic model with simulated endocardial vegetations. Antimicrob Agents Chemother. 2008;52(3):831–6.

    Article  CAS  PubMed  Google Scholar 

  52. Al-Omari A, Cameron DW, Lee C, Corrales-Medina VF. Oral antibiotic therapy for the treatment of infective endocarditis: a systematic review. BMC Infect Dis. 2014;14:140.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Aris A, Pomar JL, Saura E. Cardiopulmonary bypass in HIV-positive patients. Ann Thorac Surg. 1993;55(5):1104–7.

    Article  CAS  PubMed  Google Scholar 

  54. Byrne JG, Rezai K, Sánchez JA, Bernstein RA, Okum E, Leacche M, et al. Surgical management of endocarditis: the society of thoracic surgeons clinical practice guideline. Ann Thorac Surg. 2011;91(6):2012–9.

    Article  PubMed  Google Scholar 

  55. Nakano K, Ishibashi-Ueda H, Kobayashi J, Sasako Y, Yagihara T. Tricuspid valve replacement with bioprostheses: long-term results and causes of valve dysfunction. Ann Thorac Surg. 2001;71(1):105–9.

    Article  CAS  PubMed  Google Scholar 

  56. Arbulu A, Holmes RJ, Asfaw I. Surgical treatment of intractable right-sided infective endocarditis in drug addicts: 25 years’ experience. J Heart Valve Dis. 1993;2(2):129–37.

    CAS  PubMed  Google Scholar 

  57. Gaca JG, Sheng S, Daneshmand M, Scott Rankin J, Williams ML, O’Brien SM, et al. Current outcomes for tricuspid valve infective endocarditis surgery in North America. Ann Thorac Surg. 2013;96(4):1374–81.

    Article  PubMed  Google Scholar 

  58. Mestres CA, Miró JM, Paré JC, Pomar JL. Six-year experience with cryopreserved mitral homografts in the treatment of tricuspid valve endocarditis in HIV-infected drug addicts. J Heart Valve Dis. 1999;8(5):575–7.

    CAS  PubMed  Google Scholar 

  59. Cardarelli MG, Gammie JS, Brown JM, Poston RS, Pierson III RN, Griffith BP. A novel approach to tricuspid valve replacement: the upside down stentless aortic bioprosthesis. Ann Thorac Surg. 2005;80(2):507–10.

    Article  PubMed  Google Scholar 

  60. Kaiser S, Melby SJ, Zierer A, Schuessler RB, Moon MR, Moazami N, et al. Long-term outcomes in valve replacement surgery for infective endocarditis. Ann Thorac Surg. 2007;83(1):30–5.

    Article  PubMed  Google Scholar 

  61. Dawood MY, Cheema FH, Ghoreishi M, Foster NW, Villanueva RM, Salenger R, et al. Contemporary outcomes of operations for tricuspid valve infective endocarditis. Ann Thorac Surg. 2015;99(2):539–46.

    Article  PubMed  Google Scholar 

  62. Martín-Dávila P, Navas E, Fortún J, Moya JL, Cobo J, Pintado V, et al. Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size. Am Heart J. 2005;150(5):1099–106.

    Article  PubMed  Google Scholar 

  63. De Rosa FG, Cicalini S, Canta F, Audagnotto S, Cecchi E, Di Perri G. Infective endocarditis in intravenous drug users from Italy: the increasing importance in HIV-infected patients. Infection. 2007;35(3):154–60.

    Article  PubMed  Google Scholar 

  64. Lemma M, Vanelli P, Beretta L, Botta M, Antinori A, Santoli C. Cardiac surgery in HIV-positive intravenous drug addicts: influence of cardiovascular bypass on the progression to AIDS. Thorac Cardiovasc Surg. 1992;40(5):279–82.

    Article  CAS  PubMed  Google Scholar 

  65. Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M. Endocarditis caused by Staphylococcus aureus: a reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. Medicine (Baltimore). 2009;88(1):1–22.

    Article  Google Scholar 

  66. Musci M, Siniaswki H, Pasic M, Grauhan O, Weng Y, Meyer R, et al. Surgical treatment of right-sided active infective endocarditis with or without involvement of the left heart: 20-year single center experience. Eur J Cardiothorac Surg. 2007;32(1):118–25.

    Article  PubMed  Google Scholar 

  67. Ortiz-Bautista C, López J, García-Granja PE, Sevilla T, Vilacosta I, Sarriá C, et al. Current profile of infective endocarditis in intravenous drug users: the prognostic relevance of the valves involved. Int J Cardiol. 2015;187:472–4.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain

    Isidre Vilacosta MD, PhD, Carmen Olmos Blanco MD, PhD & Carlos Ferrera Durán MD

  2. Department of Internal Medicine and Infectious Diseases, Hospital Universitario de la Princesa, Madrid, Spain

    Cristina Sarriá Cepeda MD, PhD

  3. Instituto de Ciencias Del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain

    Javier López Díaz MD, PhD & José Alberto San Román Calvar MD, PhD

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  1. Isidre Vilacosta MD, PhD
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  2. Carmen Olmos Blanco MD, PhD
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  3. Cristina Sarriá Cepeda MD, PhD
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  4. Javier López Díaz MD, PhD
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  6. José Alberto San Román Calvar MD, PhD
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Correspondence to Isidre Vilacosta MD, PhD .

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  1. Cardiology Department, Hôpital La Timone, Marseille, France

    Gilbert Habib

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Vilacosta, I., Olmos Blanco, C., Sarriá Cepeda, C., López Díaz, J., Ferrera Durán, C., San Román Calvar, J.A. (2016). Right-Heart Endocarditis. In: Habib, G. (eds) Infective Endocarditis. Springer, Cham. https://doi.org/10.1007/978-3-319-32432-6_15

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