Echocardiographic diagnosis of tricuspid valve endocarditis in a child with a normal heart. Special emphasis on surgical considerations.

A previously healthy 8-year-old girl with a normal heart had development of tricuspid valve staphylococcal endocarditis. Serial two-dimensional echocardiograms first demonstrated an enlarging vegetation and later showed reduction in its size coincident with a pulmonary embolus. The occurrence of the pulmonary embolus along with persistent fevers, despite adequate antibiotic treatment, prompted surgical intervention. Surgical excision of a large residual vegetation, valve debridement, and pulmonary embolectomy led to prompt subsidence of fever and improvement in the patient's condition. Three months after surgery, the child remained asymptomatic with minimal tricuspid insufficiency. However, by eight months after surgery, the hemodynamic consequences of the tricuspid insufficiency had progressed, and the patient is mildly symptomatic. Additional tricuspid valve repair or replacement is expected.