[Right heart endocarditis]

Symptoms, cause and survival in 11 patients with right heart endocarditis hospitalized from 1973 to April 1989 were analyzed. The main symptoms were high fever, chest pain and dyspnea due to septic pulmonary emboli. The age of the 6 men and 5 women ranged from 19 to 66 years. 9 intravenous drug abusers and a patient with a pacemaker and carcinoma of the colon had tricuspid valve endocarditis. In another patient without known risk factors the aortic valve was affected as well. Staphylococcus aureus was isolated in 9 cases, in two as a double infection with Candida albicans and streptococcus group G respectively; beta-hemolytic streptococci group A and enterococci were found in the two remaining patients. Based on the well known high sensitivity of 2D-echocardiography, only cases with detectable tricuspid valve vegetations have been included in this retrospective study since this method became available. 10 patients were treated by antibiotics. In a single patient the tricuspid valve was removed after antibiotic pretreatment and an artificial valve was implanted 7 months later. Two patients died, one a few days after admission due to overwhelming sepsis, and one from intracerebral hemorrhage caused by an embolized aortic valve vegetation. The other patients have survived for a mean 44 months (range 2 to 183 months). Endocarditis of the right heart differs from left heart endocarditis through its typical clinical presentation, a different spectrum of microorganisms and a favourable outcome under antibiotic treatment.