CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 5, June 2013
AFRICA
173
follow-up period of 15.5
±
6.8 months (range 6–30 months), a
relapse occurred in two patients. Severe right heart failure was
seen in three cases and one fatality was reported.
Discussion
Right-sided location during infective endocarditis is rare. It
accounts for 5–10% of cases of endocarditis, according to the
literature.
2-6
Right-sided endocarditis is most often reported in
Africa, in very few cases. For instance, Ndiaye
et al
. in Sénégal
11
and Compaoré
et al
. in Moroco
12
reported six cases each. In
South Africa, Naidoo
et al
. reported 15 cases.
13
We reported
14 cases, which represented 29.1% of all infective endocarditis
during the study period.
Right-sided endocarditis is most often described in drug
addicts and in iatrogenic infections (catheter, post-surgery)
where venous access is the point of entry for the bacteria. In fact,
about 80% of tricuspid endocarditis is found in drug addicts.
14
In our study, venous access was implicated in 85.7% of
cases. Immunosuppression, which is a risk factor for right-sided
endocarditis,
15,16
was found in three patients in our cohort. In
terms of aetiology, the microorganism most frequently isolated
was
Staphylococcus aureus.
17
The clinical feature is almost invariably represented by the
infectious syndrome. In some cases tricuspid syndrome can
be found. This is a long-term fever associated with pneumonia
(usually asymptomatic), anaemia and microscopic haematuria, as
described by Nandakumar and Raju.
18
Six cases were identified
in our series.
The main diagnostic tool in our study was echocardiography
Doppler, by highlighting vegetations on the valves. Blood
sample cultures were positive in 78.5% of cases.
Treatment of infective endocarditis is based on massive
synergic long-term antibiotic therapy. The outcome is usually
favourable.
17,19,20
The prognosis of right-sided endocarditis is
usually excellent with medical treatment.
17
Complications are
most often haemodynamic. They depend on the degree of
valvular damage but also on underlying heart disease. Two cases
of death were recorded in our study because of septic shock.
Conclusion
This study shows that right-sided endocarditis is common in our
practice. This infection is prevalent in patients with congenital
heart disease or peripartum cardiomyopathy. The entry point
for microorganisms is almost exclusively the intravenous route.
Blood cultures can in most cases identify the bacterium. These
findings require health workers to pay more attention to the
maintenance of venous access in patients receiving intravenous
treatment.
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Fig. 3. Two-dimensional echocardiography, parasternal
short-axis view showing vegetations on the pulmonary
valves and pulmonary artery trunk.
