Right-sided infective endocarditis with coronary sinus vegetation.

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Infective endocarditis (IE) is a high-mortality disease, with right-sided IE comprising 5-10% of cases.
• Coronary sinus (CS) vegetation is an uncommon manifestation of IE, often affecting the tricuspid valve.
• Limited data exists on the diagnosis, treatment, and outcomes of CS vegetation.

Observation:

• A 71-year-old male presented with cough and fever, diagnosed with Staphylococcus aureus IE.
• Echocardiography revealed an aneurysmal dilated CS with mobile vegetation and a sinus venosus atrial septal defect.
• The patient experienced recurrent septic lung emboli, confirmed by CT, necessitating surgical intervention.

Findings:

• Positive blood cultures and echocardiography are key diagnostic criteria for right-sided IE with CS vegetation.
• Treatment strategies for CS vegetation include medical management and surgical options.
• Successful surgical repair of the atrial septum and removal of CS vegetation led to patient recovery.

Implications:

• Individualized surgical strategies are crucial for CS vegetation due to controversial indications and timing.
• Prompt diagnosis and appropriate treatment, including surgery when indicated, lead to good prognoses.
• This case underscores the importance of considering rare IE locations like the CS in clinical practice.