Tricuspid Valve Reconstruction for Endocarditis in a Premature Newborn

Endocarditis in premature infants without congenital heart disease is exceedingly rare. We describe a case of a premature infant who required surgical intervention for tricuspid endocarditis. The patient was a former 30-week gestation infant who was transferred to our facility at 18 days of age.

Echocardiogram revealed a new mass on the tricuspid valve measuring 6 mm in diameter, without evidence of stenosis or regurgitation. Blood culture was positive for methicillin sensitive staphylococcus aureus, and he was started on antibiotic therapy with vancomycin and gentamicin. Repeat echo on day of life 16 showed the vegetation had grown to 6 x 8 mm in size, with mild tricuspid regurgitation prompting transfer to our facility.

Over the next few days, he required supplemental oxygen and developed hepatomegaly, ascites, and peripheral edema. Echocardiogram on day of life 19 showed a larger vegetation, 10 x 8 mm with limited excursion of the leaflets. There was a mean gradient of 4-6 mmHg across the tricuspid valve and moderate regurgitation.

Due to clinical signs of systemic venous congestion and persistently positive blood cultures, the decision was made to proceed with surgery. On his 25th day of life, at a corrected gestational age of approximately 33 weeks and a weight of 2 kg, the infant was taken to the operating room for tricuspid valve repair.

An echocardiogram from post-operative day 22 demonstrated normal systolic ventricular function, moderate TR, predominantly right to left shunting at the PFO, and a mean gradient of 1 mm Hg across the tricuspid valve.

The patient is currently 3 months old, with a corrected gestational age of 45 weeks. He is on minimal oxygen support and is tolerating oral feeds.

Reference

1. Day MD, Gauvreau K, Shulman S, Newburger JW. Characteristics of children hospitalized with infective endocarditis. Circulation. 2009;119:865-870.

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