Édgar G. Ríos, Servicio de Cirugía Cardiovascular, Hospital de San José, Bogotá, Colombia
Daniela Ramírez, Servicio de Medicina de Urgencias, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
Fredy Forero, Servicio de Medicina Interna, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
Valentina Villarreal, Unidad de Investigaciones, Sociedad de Cirugía de Bogotá, Hospital de San José, Bogotá, Colombia
Paula C. Rodríguez, Servicio de Cirugía General, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
Infective endocarditis (IE) primarily affects native heart valves, with the mitral and tricuspid valves being the most impacted, particularly in intravenous drug users and immunosuppressed individuals. Although right-sided IE is less prevalent, it is associated with poorer clinical outcomes. Diagnosing IE caused by these streptococci can be challenging due to their slow growth, which often results in negative culture results. We present the case of a 53-year-old woman who developed vegetation on both the mitral and tricuspid valves. She was treated with antibiotics and underwent surgery, which involved resection of the vegetation and mechanical mitral valve replacement, along with tricuspid valve repair. Early surgical intervention proved to be crucial for her recovery. Effective management of complex IE cases requires a multidisciplinary and personalized approach. Surgical decisions should consider clinical factors such as heart failure or uncontrolled infection rather than solely the size of the vegetation. While valve repair is generally preferred, valve replacement may be necessary in cases of extensive infection. This case underscores the importance of comprehensive surgical and medical management in achieving favorable outcomes in rare instances of multivalvular IE without subsequent complications.
Keywords: Infective endocarditis. Large vegetation. Mitral valve. Tricuspid valve.
