Tricuspid Valve Infective Endocarditis With Biventricular Thrombi: An Unusual Presentation

Biventricular thrombi (BVT) is a rare presentation associated with high morbidity and mortality due to the potential sequela of life-threatening complications including embolic events and cardiac failure. As an uncommon entity, there is limited research on best practice for the management of BVT.

We present a case of BVT with Streptococcus anginosus and Staphylococcus hominis concomitant bloodstream infection, tricuspid valve infective endocarditis (TVIE), septic emboli and decompensated dilated cardiomyopathy (LVEF 20%-25%). Guideline directed heart failure management, antimicrobials and anticoagulation were initiated with a remarkable recovery within 2 months.

Given the rarity of this presentation, a multidisciplinary approach was taken to guide management. Follow-up echocardiography after completion of antimicrobial therapy demonstrated an LVEF of 53%, no detectable thrombus and resolution of congestive symptoms. Although there is minimal population-based evidence, this case supports a conservative approach for the treatment of TVIE, BVT and its potential sequelae in select patients.