Successful surgical treatment of tricuspid valve endocarditis associated with vertebral osteomyelitis.

Right-sided endocarditis is relatively rare and can occasionally be complicated by vertebral osteomyelitis (VO). We describe successful treatment, including valve repair for tricuspid endocarditis associated with VO. A 77-year-old man presented with back pain and high fever. Magnetic resonance imaging demonstrated VO. Despite 2 months of intravenous antibiotics, the infectious signs persisted and both legs became edematous. Enterococcus faecalis was isolated from blood cultures, and echocardiography showed severe tricuspid regurgitation with large vegetations attached to the anterior leaflet (AL). A series of echocardiographic assessments revealed that the antibiotic therapy did not affect the tricuspid lesions. In surgery, the infection was extended to some chordae and over half of the AL was resected. The AL was repaired with autologous pericardium and artificial chordae. Antibiotic therapy was continued for 2 months after surgery, and the infections did not reoccur. Follow-up echocardiography showed mild regurgitation of the tricuspid valve. The patient remains free from endocarditis at 2 years after surgery.