Individualized antibiotic therapy is highly effective for tricuspid valve endocarditis in drug abusers, with surgery needed only for progressive heart failure or medically refractory infection.
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Supports medical-first management in tricuspid endocarditis; case reports leave open need for prospective trials before practice change.
Isolated tricuspid valvular endocarditis is no longer rare, and its increasing incidence has paralleled the rise in heroin addiction. In the period between December, 1969 and December, 1971, 16 episodes of bacterial endocarditis occurred in 13 individual drug abusers at the Ben Taub General Hospital, Houston. The tricuspid valve (TV) was involved in all cases. Two patients required surgery during the acute infection; one underwent total excision of the TV without replacement, and one received aortic and TV prostheses because of progressive heart failure. Antibiotic therapy was individualized and guided by tube dilution sensitivities and serum bactericidal levels. In view of the excellent response to antibiotic therapy, surgery for infected prosthetic or natural valves is presently reserved for those patients with progressive cardiac failure or infections unresponsive to medical therapy.
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Graham et al. (1973) studied this question.
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